Nail Clippings Research Articles

Use of Restriction Fragment Length Polymorphism to Rapidly Identify Dermatophyte Species Related to Dermatophytosis

Background:Dermatophytes are a group of keratinophilic fungi worldwide, which can infect the skin, hair and nails of humans and animals. This genus includes several species that present different features of dermatophytosis. Although, laboratory diagnosis of dermatophytes is based on direct microscopy, biochemical tests and culture, these manners are expensive, time consuming and need skilled staff. Therefore, molecular methods like PCR-RFLP are the beneficial tools for identification, which are rapid and sensitive. Thus, dermatophyte species are able to generate characteristic band patterns on agarose gel electrophoresis using PCR-RFLP technique, which leads to successful identification at the species level within a 5-hour period.Objectives:The purpose of this study was to study inter- and intraspecific genomic variations for identification of clinically important dermatophyte species obtained from clinical specimens in Isfahan, Iran using PCR-RFLP.Materials and Methods:From March 2011 to August 2012, 135 clinical isolates were collected from infected patients at Isfahan, Iran. ITS1-5.8S-ITS2 region of rDNA was amplified using universal fungal primers. Subsequently, amplified products were digested by the MvaI restriction enzyme. Using discriminating band profiles on agarose gel, dermatophyte species were identified. However, DNA sequencing was used for unidentifiable strains.Results:The specimens were obtained from skin scrapings (70.3%), nail (24.4%) and hair (5.1%) clippings. Most patients were between 21 - 30 years and the ratio of male to female was 93/42. Trichophyton interdigitale was the commonest isolate (52.5%) in our findings, followed by Epidermophyton floccosum (24.4%), T. rubrum (16.2%), Microsporum canis (2.2%), T. erinacei (1.4%), T. violaceum (1.4%), T. tonsurans (0.7%) and M. gypseum (0.7%) based on PCR-RFLP.Conclusions:Combination of traditional methods and molecular techniques considerably improves identification of dermatophytes in the species level in clinical laboratories, which can lead to properly antifungal therapy and successful management of infections. However, restriction and specificity and sensitivity should be lowered and increased, respectively, to be useful for a wide variety of clinical applications.

Cutting and Seed Propagation of Chickasaw Plum (Prunus angustifolia)

Chickasaw plum (Prunus angustifolia Marsh.) has the potential to be planted for windbreaks, wildlife, and for human consumption; however, reliable propagation protocols need to be established. Propagation of plants by seed using mechanical scarification treatment and stratification as well as stem cuttings using selected rooting hormone rates for Chickasaw plum were investigated. Seeds and stem cuttings of previous year’s growth were collected in Payne County, Oklahoma. Seed stratification treatments included 0, 30, or 60 d at 3°C. Mechanical scarification employed tip removal from seeds with a nail clipper. Stem cuttings were treated with five IBA rates (0, 100, 1000, 3000, and 7000 mg·L−1) in factorial combination with three collection times (May, August, and October). Scarifying the seed coat did not affect germination percentage. Non-scarified seeds stratified 60 d at 3°C had the highest germination at 31%. The time of year for cutting selection and amount of IBA rooting hormone applied was critical for rooting success. Rooting success was greatest at the highest IBA concentration when cuttings were harvested in May or August (44% and 49%), respectively.

Mercury and psychosocial stress exposure interact to predict maternal diurnal cortisol during pregnancy.

BackgroundDisrupted maternal prenatal cortisol production influences offspring development. Factors influencing the hypothalamic-pituitary-adrenal axis include social (e.g., stressful life events) and physical/chemical (e.g., toxic metals) pollutants. Mercury (Hg) is a common contaminant of fish and exposure is widespread in the US. No prior study has examined the joint associations of stress and mercury with maternal cortisol profiles in pregnancy.ObjectivesTo investigate potential synergistic influences of prenatal stress and Hg exposures on diurnal cortisol in pregnant women.MethodsAnalyses included 732 women (aged 27.4 ± 5.6 years) from a Mexico City pregnancy cohort. Participants collected saliva samples on two consecutive days (mean 19.52 ± 3.00 weeks gestation) and reported life stressors over the past 6 months. Hg was assessed in toe nail clippings collected during pregnancy.ResultsThere were no main effects of Hg or psychosocial stress exposure on diurnal cortisol (ps > .20) but strong evidence of interaction effects on cortisol slope (interaction B = .006, SE = .003, p = .034) and cortisol at times 1 and 2 (interaction B = -.071, SE = .028, p = .013; B = -.078, SE = .032, p = .014). Women above the median for Hg and psychosocial stress exposure experienced a blunted morning cortisol response compared to women exposed to higher stress but lower Hg levels.ConclusionsSocial and physical environmental factors interact to alter aspects of maternal diurnal cortisol during pregnancy. Research focusing solely on either domain may miss synergistic influences with potentially important consequences to the offspring.

Onychomycosis in two geographically distinct regions in India

Background: Onychomycosis is worldwide in distribution and the genera of causative agents are diverse. This study was carried out to demonstrate if the causative agents differed with a difference in temperature, climate and locale. Methods: Seventy patients in coastal tropical region of Karnataka and fifty patients in the hilly temperate region of Sikkim with clinical signs of onychomycosis attending the deramtology outpatient department were included. The screening of the nail clippings was done by microscopy and confirmed by culture. Findings: Fusarium Spp was the most common isolate (45.5%) in Karnataka and Dermatophyte (61.1%) in Sikkim. Conclusion: Different geographical regions may have different etiological agents. The role of non dermatophytes in the etiology of onychomycosis should not be overlooked.

Diagnostic applications of nail clippings.

"Nail clipping is a simple technique for diagnosis of several nail unit dermatoses. This article summarizes the practical approach, utility, and histologic findings of a nail clipping in evaluation of onychomycosis, nail unit psoriasis, onychomatricoma, subungual hematoma, melanonychia, and nail cosmetics, and the forensic applications of this easily obtained specimen. It reviews important considerations in optimizing specimen collection, processing methods, and efficacy of special stains in several clinical contexts. Readers will develop a greater understanding and ease of application of this indispensable procedure in assessing nail unit dermatoses."

Comparison of diagnostic methods for onychomycosis, and proposal of a diagnostic algorithm.

Traditionally, the gold standard for diagnosis of onychomycosis has been the combination of direct microscopy with potassium hydroxide (KOH) staining and fungal culture. However, several studies have suggested that periodic-acid-Schiff (PAS) staining of nail-plate clippings may be a very sensitive method for the diagnosis of onychomycosis. To compare the sensitivities of direct microscopy with KOH, fungal culture and PAS staining of nail-plate clippings, and to define an efficient, high-yield and cost-effective diagnostic strategy for the diagnosis of onychomycosis in the clinical setting. We evaluated a total of 493 patients with clinically suspected onychomycosis. Group A comprised 400 patient samples, evaluated using fungal culture and PAS stain, while group B comprised 93 patient samples evaluated using KOH, fungal culture and PAS. Diagnosis of onychomycosis was defined as clinical morphology plus at least one positive test result. In group A, sensitivities of fungal culture and PAS were 49.5% and 93.1% (P < 0.005), respectively. In group B, the most sensitive single test was PAS (88.2%) followed by KOH (55.9%) and fungal culture (29.4%). The combination of fungal culture and PAS (94.1%) was significantly (P < 0.001) more sensitive than that of KOH and culture (72.1%). PAS staining of nail clippings is much more sensitive than KOH and fungal culture for the diagnosis of onychomycosis. Based on our results, we propose a diagnostic algorithm for onychomycosis that takes into consideration the sensitivity, cost-effectiveness and necessary time for each test.

Role of Titanium in the Development of Yellow Nail Syndrome

Yellow nail syndrome (YNS) is characterized by the triad of nail changes, lymphedema and respiratory tract involvement. Several hypotheses have been postulated to explain the findings in YNS including lymphatic drainage abnormalities along with microvasculopathy. The most recent hypothesis, proposed by Berglund and Calmark [Biol Trace Elem Res 2011;143:1-7], suggests a role of titanium dioxide in the development of YNS. This study showed elevated titanium levels (ranging from 1.1 to 170 μg/g of nail plate) in nail clippings or pieces of shed nail from 30 patients with YNS. Titanium was not found in the nails of healthy patients. Complete resolution was seen in 4 patients after removal of their titanium implants. Titanium dioxide is commonly found in cosmetics, sunscreens, medications, confectionaries and joint implants. Exposure to titanium can lead to its ions being released by galvanic action of dental gold or amalgam through the oxidative stress of fluorides. It is hypothesized that this galvanic interaction may lead to the yellow discoloration. At this point, cause and effect is speculative, but titanium may play a role in a subgroup of patients with YNS.

Hand Washing with Soap and Nail Clipping: Effect on Anaemia and Thinness in School-aged Children in Ethiopia: A Factorial Randomised Controlled Trial

Hand Washing with Soap and Nail Clipping: Effect on Anaemia and Thinness in School-aged Children in Ethiopia: A Factorial Randomised Controlled Trial

Prevalencia del VIH y conductas de riesgo en internos de un centro carcelario del distrito de Barranquilla (Colombia)

Objectives: Describe HIV prevalence and risk behaviors in inmates of the penitenciary of the district of Barranquilla. Method: A descriptive study was conducted with 100 inmates of penitenciary of the District of Barranquilla. We used a questionnaire designed by the authors to determine the prevalence of HIV and risk behaviors validated by expert judges and pilot test. Data processing was performed with the Statistical Package to Social Sciences SPSS version 21. Results: 11 % of inmates are HIV-positive; 54 % have been remained in the penitenciary between 2 and 3 years sharing cell with 3 to 6 inmates (85 %); 33 % do not use protection in sexual relationships with practices of oral sex (85 %), anal and vaginal sex (31 %) respectively carried out 1 to 2 times a week (88 %). The personal items that are mostly sharing are: soap (64 %) and nail clippers (53 %). The most consumed psychoactive substances are marijuana (74 %) and alcohol (52 %). Inmates have had contact with tuberculosis (54 %) and HIV/AIDS (43%). Conclusions: The HIV and others risk behaviors are public health problems in the inmates population, who are considered highly vulnerable.

A Cross-Sectional, Clinico-Mycological Research Study of Prevalence, Aetiology, Speciation and Sensitivity of Superficial Fungal Infection in Indian Patients

Introduction: Skin is a mechanically protective layer as well as cosmetically significant anatomical structure. The superficial cutaneous fungal infections involve its outer most covering including appendages like hair and nails. This the most common causes of skin disease in many tropical countries. Objectives: To study the prevalence, aetiology, speciation and sensitivity of superficial fungal infections. Materials and Methods: The study was conducted on 100 clinically diagnosed cases of Superficial Fungal Infection attending the Dermatology OPD for a period of 6 months. Detailed history was taken in relation to age, sex, duration of illness, personal history, recurrent infections etc. Clinical examination of lesion included number, types of lesions, scaling, presence of crusts or pustules, scarring, black dot appearances, hair lusture etc. Samples like skin scrapings, hair stubs, nail clippings and pus were collected for KOH study and fungal culture. Results: Dermatophyte infection mostly Tinea corporis is found to be more in male in 20-30 years age group of population. Covered part of the body is affected more and commonly hygiene plays a major part of its occurrence. KOH positivity is found in 68% and culture positivity in 88.2% of the clinically diagnosed cases with Trichophyton species as the commonest. Fluconazole and Clotrimazole found to be highly sensitive ; Ketoconazole fount to be partially sensitive with 65% . Conclusion: Dermatophytes were the commonest mycological isolate with Trichophyton rubrum as the common infecting species. Young male preponderance with involvement of covered areas of the body of both skilled and unskilled workers. This can be prevented by a meticulous personal hygiene. Fluconazole and Clotrimazole found to be highly sensitive.

Human Nail Clippings as a Source of DNA for Genetic Studies.

Blood samples have traditionally been used as the main source of DNA for genetic analysis. However, this source can be difficult in terms of collection, transportation, and long-term storage. In this study, we investigated whether human nail clippings could be used as a source of DNA for SNP genotyping, null-allele detection, and whole-genome amplification. From extracted nail DNA, we achieved amplicons up to a length of ~400 bp and >96% concordance for SNP genotyping and 100% concordance for null-allele detection compared to DNA derived from matched blood samples. For whole-genome amplification, OmniPlex performed better than Multiple Displacement Amplification with a success rate of 89.3% and 76.8% for SNP genotyping and null-allele detection, respectively. Concordance was ~98% for both methods. When combined with OmniPlex whole-genome amplification, human nail clippings could potentially be used as an alternative to whole blood as a less invasive and more convenient source of DNA for genotyping studies.

Nail clipper ergonomic evaluation and redesign for the elderly

This study designs and evaluates a new nail clipper for the elderly using ergonomic methods. The nail clipper usage problems and requirements were collected first. After requirement analysis we applied ergonomic simulation in redesigning the nail clipper and developing a pedal plate. A usability test was conducted to evaluate both typical and newly developed nail clippers using 20 elder participants. The dependent measures were the total number of nails clipped, completion time and discomfort and satisfaction subjective ratings. The experimental results indicated that the newly developed nail clipper was superior to the typical one in subjective ratings for discomfort and satisfaction. The performance of the newly-developed nail clipper is similar to that of the typical clipper. Some important nail clipper design implications for the ageing population are discussed. Relevance to industryWith the increase in the elderly population, problems caused by aging have gradually emerged. Aging may cause the elderly inconvenience in using many household objects that are not specifically designed for the elderly. Therefore, industrial designers should try to redesign household objects to enhance living quality for the elderly. This study used nail clipper design as an example to show how to apply ergonomic methods in product design.

Infections and infestations of the skin

Abstract Childhood skin infections and infestations are common clinical conditions which present to paediatricians, GPs and specialist nurses. Diagnosis of these conditions is often based on history and clinical findings but can be aided by skin swabs for culture and/or virology, skin scrapings, plucked hair or nail clippings for fungal culture and by skin biopsies. It is important to ensure accurate diagnosis to prevent complications and avoid unnecessary investigations or procedures. If doubt exists then children should be referred to a paediatric dermatologist. Treatment of complex skin infections or immunocompromised children should always be undertaken following the advice of a paediatric infectious disease consultant.

DNA profiles from fingernails using direct PCR.

We report on the successful routine amplification of DNA profiles from small sections of fingernails using direct PCR. The data are from 40 nail clippings from eight donors where approximately 4 mm(2) of nail is added directly to the PCR. The NGM™ kit was used that amplifies 15 STR loci plus amelogenin. No increase in cycle number was used and no enrichment of the PCR products was performed. Full DNA profiles were observed in 17 of the 40 profiles with 21 generating partial DNA profiles. The process omits the DNA extraction process, and hence there is no opportunity to quantify the DNA prior to amplifying the STRs, but by not performing a DNA extraction step, the amount of DNA available for PCR is maximized. Single source DNA profiles were observed in 29 of the 38 profiles obtained. The source of the DNA is assumed to be adhering to the underside of the nail. This simple method offers a significant reduction in time to generate DNA profiles from nail clippings, such as those taken from victims of mass disasters, and should be included into a forensic process relatively easily as it requires no change to manufacturer's instructions for amplification.

安全型糖尿病足趾甲修剪钳的研制与应用*

Objective: To evaluate the clinical application effects of new type secure toenail clipper for diabetes patients. Methods: Combining advantages and abandoning shortcomings of common nail clippers and scissors, designed a new type toenail clipper for diabetes patients with abnormal and (or) hard toenails, and applied it in 450 diabetes patients. Results: Easy application with safety and effective pruning. After pruning, the pain and oppression feeling caused by abnormal and (or) hard toenails relieved, and no case had diabetic foot ulcer. Conclusions: The new type secure toenail clipper can effectively reduce the sense of pain and oppression, and decrease the incidence of diabetic foot ulcer.

Superficial Fungal Infections in Renal Transplant Recipients

BackgroundRenal transplant recipients (RTRs) are predisposed to fungal infections because of long-term graft-preserving immunosuppressive therapy. MethodsWe prospectively enrolled 223 consecutive adult RTRs. Patients were transplanted at 1 of 2 transplant centers in Poland. The group consisted of 97 women (43%) and 126 men (57%). The control group consisted of 100 patients (39 women and 61 men) randomly selected from the outpatient dermatology clinic and from hospital personnel. All RTRs and the control group were screened for the presence of superficial fungal infections. All patients were examined by the same dermatologist. The oral mucosa and the entire body surface were fully examined. Mucosal swabs were obtained from all patients in both the examined and control groups. Skin scrapings and swabs were obtained from any clinically suspicious lesions. Nail clippings were collected in the case of any nail changes. ResultsSuperficial fungal infections have been detected in 133 RTRs (60%)and 27 controls (27%; P = .00001). One hundred eight RTRs (62%) developed superficial fungal infections in the first year after transplantation (P < .008). The most common site for superficial fungal infections in the RTRs group was the oral cavity. Candida albicans was the most frequently isolated species in the oral cavity. ConclusionsSuperficial fungal infections in RTRs are statistically more common among RTRs than in the general population. Whether the drug was used separately or administrated under immunosuppressive combinations had no influence on the occurrence of fungal infections. The final results showed no correlation between patient age and the occurrence of fungal infections. Dermatologists who care for transplant patients should be aware of the clinical course of fungal species in RTRs compared with the general population.

Development and validation of an ex vivo electron paramagnetic resonance fingernail biodosimetric method.

There is an imperative need to develop methods that can rapidly and accurately determine individual exposure to radiation for screening (triage) populations and guiding medical treatment in an emergency response to a large-scale radiological/nuclear event. To this end, a number of methods that rely on dose-dependent chemical and/or physical alterations in biomaterials or biological responses are in various stages of development. One such method, ex vivo electron paramagnetic resonance (EPR) nail dosimetry using human nail clippings, is a physical biodosimetry technique that takes advantage of a stable radiation-induced signal (RIS) in the keratin matrix of fingernails and toenails. This dosimetry method has the advantages of ubiquitous availability of the dosimetric material, easy and non-invasive sampling, and the potential for immediate and rapid dose assessment. The major challenge for ex vivo EPR nail dosimetry is the overlap of mechanically induced signals and the RIS. The difficulties of analysing the mixed EPR spectra of a clipped irradiated nail were addressed in the work described here. The following key factors lead to successful spectral analysis and dose assessment in ex vivo EPR nail dosimetry: (1) obtaining a thorough understanding of the chemical nature, the decay behaviour, and the microwave power dependence of the EPR signals, as well as the influence of variation in temperature, humidity, water content, and O₂ level; (2) control of the variability among individual samples to achieve consistent shape and kinetics of the EPR spectra; (3) use of correlations between the multiple spectral components; and (4) use of optimised modelling and fitting of the EPR spectra to improve the accuracy and precision of the dose estimates derived from the nail spectra. In the work described here, two large clipped nail datasets were used to test the procedures and the spectral fitting model of the results obtained with it. A 15-donor nail set with 90 nail samples from 15 donors was used to validate the sample handling and spectral analysis methods that have been developed but without the interference of a native background signal. Good consistency has been obtained between the actual RIS and the estimated RIS computed from spectral analysis. In addition to the success in RIS estimation, a linear dose response has also been achieved for all individuals in this study, where the radiation dose ranges from 0 to 6 Gy. A second 16-donor nail set with 96 nail samples was used to test the spectral fitting model where the background signal was included during the fitting of the clipped nail spectra data. Although the dose response for the estimated and actual RIS calculated in both donor nail sets was similar, there was an increased variability in the RIS values that was likely due to the variability in the background signal between donors. Although the current methods of sample handling and spectral analysis show good potential for estimating the RIS in the EPR spectra of nail clippings, there is a remaining degree of variability in the RIS estimate that needs to be addressed; this should be achieved by identifying and accounting for demographic sources of variability in the background nail signal and the composition of the nail matrix.

High-Quality DNA from Fingernails for Genetic Analysis

The availability of high-quality germline DNA is an important prerequisite for a variety of genetic analyses. We have shown previously that fingernail clippings provide an optimal source of autologous, constitutional DNA for PCR-based applications. However, most existing protocols for nucleic acid purification from nails do not provide sufficiently high yields of pure and intact DNA for more demanding downstream analyses such as next generation sequencing (NGS). We have extensively tested and systematically modified a number of different protocols for DNA purification from nail material to optimize the yield and quality. The integrity of DNA was determined by PCR amplification of short (<300 bp), mid-range (>400 bp), and long-range (>2 kb) sequences using different target genes. Among the methods tested, the Prepfiler Forensic DNA Extraction kit was identified as the most appropriate approach to isolation of high-quality DNA from nail clippings. A standardized input of 20 mg nail material (1 to 10 pieces of fingernail clippings) yielded a mean of 1 μg DNA (range, 0.5 to 2.3 μg). Subsequent PCR-analysis revealed efficient amplifiability of short and mid-range targets in 93% and 90%, and long-range fragments in 60% of the samples tested. The adequacy for next generation sequencing applications was demonstrated by successful high-resolution HLA-typing in ten transplant recipients. Hence, the protocol presented facilitates the exploitation of fingernail material even for demanding genomic analyses both in research and diagnostics.

Discovery of biomarkers for glycaemic deterioration before and after the onset of type 2 diabetes: rationale and design of the epidemiological studies within the IMI DIRECT Consortium

Aims/hypothesisThe DIRECT (Diabetes Research on Patient Stratification) Study is part of a European Union Framework 7 Innovative Medicines Initiative project, a joint undertaking between four industry and 21 academic partners throughout Europe. The Consortium aims to discover and validate biomarkers that: (1) predict the rate of glycaemic deterioration before and after type 2 diabetes onset; (2) predict the response to diabetes therapies; and (3) help stratify type 2 diabetes into clearly definable disease subclasses that can be treated more effectively than without stratification. This paper describes two new prospective cohort studies conducted as part of DIRECT.MethodsPrediabetic participants (target sample size 2,200–2,700) and patients with newly diagnosed type 2 diabetes (target sample size ~1,000) are undergoing detailed metabolic phenotyping at baseline and 18 months and 36 months later. Abdominal, pancreatic and liver fat is assessed using MRI. Insulin secretion and action are assessed using frequently sampled OGTTs in non-diabetic participants, and frequently sampled mixed-meal tolerance tests in patients with type 2 diabetes. Biosamples include venous blood, faeces, urine and nail clippings, which, among other biochemical analyses, will be characterised at genetic, transcriptomic, metabolomic, proteomic and metagenomic levels. Lifestyle is assessed using high-resolution triaxial accelerometry, 24 h diet record, and food habit questionnaires.Conclusions/interpretationDIRECT will yield an unprecedented array of biomaterials and data. This resource, available through managed access to scientists within and outside the Consortium, will facilitate the development of new treatments and therapeutic strategies for the prevention and management of type 2 diabetes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-014-3216-x) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

A simple ABO genotyping by PCR using sequence-specific primers with mismatched nucleotides

In forensics, the specific ABO blood group is often determined by analyzing the ABO gene. Among various methods used, PCR employing sequence-specific primers (PCR-SSP) is simpler than other methods for ABO typing. When performing the PCR-SSP, the pseudo-positive signals often lead to errors in ABO typing. We introduced mismatched nucleotides at the second and the third positions from the 3'-end of the primers for the PCR-SSP method and examined whether reliable typing could be achieved by suppressing pseudo-positive signals. Genomic DNA was extracted from nail clippings of 27 volunteers, and the ABO gene was examined with PCR-SSP employing primers with and without mismatched nucleotides. The ABO blood group of the nail clippings was also analyzed serologically, and these results were compared with those obtained using PCR-SSP. When mismatched primers were employed for amplification, the results of the ABO typing matched with those obtained by the serological method. When primers without mismatched nucleotides were used for PCR-SSP, pseudo-positive signals were observed. Thus our method may be used for achieving more reliable ABO typing.