A novel method for measuring sublingual temperature using conventional non-contact forehead thermometer

Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperature of a patient very quickly. The aim of the study was to evaluate the utility of recording sublingual temperature using an infrared non-contact thermometer and establish its accuracy by comparing the readings with tympanic thermometer recordings. Methods: This cross-sectional study was carried out in 29 patients (328 paired recordings from sublingual and tympanic sites simultaneously). Subjects were requested to keep their mouth closed for five minutes before recording the temperature. Sublingual recordings were performed for each patient at different times of the day using an infrared thermometer. The infrared thermometer was quickly brought 1cm away from the sublingual part of the tongue and the recordings were then done immediately. Readings were compared with the corresponding tympanic temperature. Results: The non-contact sublingual temperature correlated very closely with tympanic temperature (r=0.86, p<0.001). The mean difference between the infrared sublingual and tympanic temperature was 0.21°C (standard deviation [SD]:0.48°C, 95% confidence interval [CI] of 0.16-0.27). The intra-class correlation co-efficient (ICC) between core and sublingual temperatures was 0.830 (95% CI: 0.794 to 0.861) p<0.001. The sensitivity of sublingual IR (infrared) temperature of 37.65°C was 90% and specificity was 89% for core temperature >38°C. Conclusions: This innovative modification of using the forehead infrared thermometer to measure the sublingual temperature offers an accurate, rapid and non-contact estimation of core temperature.

Durian Locule (Endocarp) Water Immersion Drinking Effect to Reduce Heaty Sensation after Flesh Consumption: A Preliminary Study

Durian is said to have a “heaty” effect on the people who have eaten it that can raise their body temperature and blood pressure. The locule water immersion is the water that is drunk using the durian’s inner skin (endocarp) that contains the durian flesh and it is said (mainly via local hearsay) that it can lower the body temperature right after consuming the flesh. The aim of this research is to investigate a myth about the effect of D24 durian locule water immersion that can possibly reduce body temperature after eating durian via oral temperature assessment. In order to explore the reliability of this myth, an experimental research was carried out with five different respondents to undergo with 3 different set of condition which are: a) consumed the same amount of durian, but they did not have to drink the immersed-locule water; b) consumed the durian and they had to drink the immersed-locule water and c) consumed the durian and they had to drink a cup of water. The changes in their body temperature (oral reading) were recorded and analysed for significant changes (n = 3). Overall, the immersed-locule water exhibited a mild affect in the changes of body temperature (p<0.05) on a short period of time (<30 mins after consumption). For that reason, the availability of pectin in the locule water-immersion might have help facilitates the natural homeostasis mechanism faster as to suppress of any sudden body heating after eating durian.

Clinical evaluation of non-contact infrared thermometers

Non-contact infrared thermometers (NCITs) are being widely used during the COVID-19 pandemic as a temperature-measurement tool for screening and isolating patients in healthcare settings, travelers at ports of entry, and the general public. To understand the accuracy of NCITs, a clinical study was conducted with 1113 adult subjects using six different commercially available NCIT models. A total of 60 NCITs were tested with 10 units for each model. The NCIT-measured temperature was compared with the oral temperature obtained using a reference oral thermometer. The mean difference between the reference thermometer and NCIT measurement (clinical bias) was different for each NCIT model. The clinical bias ranged from just under − 0.9 °C (under-reporting) to just over 0.2 °C (over-reporting). The individual differences ranged from − 3 to + 2 °C in extreme cases, with the majority of the differences between − 2 and + 1 °C. Depending upon the NCIT model, 48% to 88% of the individual temperature measurements were outside the labeled accuracy stated by the manufacturers. The sensitivity of the NCIT models for detecting subject’s temperature above 38 °C ranged from 0 to 0.69. Overall, our results indicate that some NCIT devices may not be consistently accurate enough to determine if subject’s temperature exceeds a specific threshold of 38 °C. Model-to-model variability and individual model accuracy in the displayed temperature were found to be outside of acceptable limits. Accuracy and credibility of the NCITs should be thoroughly evaluated before using them as an effective screening tool.

641. Clinical Predictors of Hospital-Acquired Bloodstream Infections

Background Hospital-acquired bloodstream infections (HABSI) are associated with increased mortality and decreased hospital quality metrics. This has led to an increased focus on blood culture stewardship. Little data exists regarding predictive factors of bacteremia in hospitalized patients. We aim to determine what clinical characteristics in patients were predictive of HABSI. Methods This is a retrospective case-control study of 540 patients with positive blood cultures admitted to our health system between September 1, 2017, to April 1, 2020. Electronic medical records of patients with positive blood cultures were independently reviewed to determine contamination versus true bacteremia. We looked at different clinical parameters and laboratory investigations within 24 hours of drawing blood cultures. Clinical variables were age ≥ 60 years, heart rate ≥ 90/minute, systolic blood pressure ≤ 90 mmHg or use of a vasopressor, oral temperature &gt; 38°Celsius (100.4°Fahrenheit), white blood cells (WBC) count ≥12,000/µL, lymphocytes ≤ 1000/mm3, platelets &lt; 150,000 /µL, and creatinine &gt;2.0 mg/dL. Stepwise logistic regression analysis was used for predictive statistical model development. Results In a cohort of 481 patients with hospital-acquired bacteremia, 350 cases had true bacteremia and 131 cases were contaminated blood cultures. Stepwise regression analysis showed that white blood cell (WBC) count ≥ 12,000 cells/µL, lymphocyte count ≤ 1000/mm3, creatinine &gt; 2.0 mg/dL, and oral temperature &gt; 38°C (100.4°F) were associated with HABSI (R-square= 0.06, p value= 0.002). Conclusion Our findings suggest that WBC count, lymphocyte count, creatinine, and oral temperature together can be used to develop appropriate blood culture stewardship models in the inpatient setting. This may help minimize unnecessary blood cultures. Disclosures All Authors: No reported disclosures

Objective Measurements Associated with the Preferred Eating Qualities of Fermented Salamis

The development of new food products can be expedited by understanding the physicochemical attributes that are most relevant to consumers. Although many objective analyses are possible, not all are a suitable proxy to serve as quality markers associated with sensory preferences. In this work, we selected nine candidate laboratory assays to use on six commercial salamis, which were also eaten and informally described by a consumer discussion group familiar with China-sourced meat products. Several objective measures were strongly related to the flavour perceptions: (i) texture: instrumental texture values, fat release at oral temperature and fat saturation ratios, (ii) aroma: volatile compounds (e.g., alcohols and esters) associated with microbial fermentation and spices (terpenes and sulphur compounds) and (iii) taste: kokumi taste receptor responses. The fat released at oral temperature was associated with unsaturated fatty acids (r = 0.73). However, there was less explanatory worth for associations between sensory perceptions and proximate composition, water activity, pH or L*, a*, b* colourimetry.

Clinical Evaluation of Non-Contact Infrared Thermometers

Background:Non-contact infrared thermometers (NCITs) are being widely used during the COVID-19 pandemic as a temperature-measurement tool for screening and isolating patients in healthcare settings, travelers at ports of entry, and the general public. Methods:To understand the accuracy of NCITs, a clinical study was conducted with 1113 adult subjects using six different commercially available NCIT models. A total of 60 NCITs were tested with 10 units for each model. The NCIT-measured temperature was compared with the oral temperature obtained using a reference oral thermometer. Results:The mean difference between the reference thermometer and NCIT measurement (clinical bias) was different for each NCIT model. The clinical bias ranged from just under -0.9 °C (under-reporting) to just over 0.2 °C (over-reporting). The individual differences ranged from -3 °C to +2 °C in extreme cases, with the majority of the differences between -2 °C and +1 °C. Depending upon the NCIT model, 48% to 88% of the individual temperature measurements were outside the labeled accuracy stated by the manufacturers. The sensitivity of the NCIT models for detecting subject’s temperature above 38 °C ranged from 0 to 0.69. Conclusions: Overall, our results indicate that some NCIT devices may not be consistently accurate enough to determine if subject’s temperature exceeds a specific threshold of 38 °C. Model-to-model variability and individual model accuracy in the displayed temperature were found to be outside of acceptable limits. Accuracy and credibility of the NCITs should be thoroughly evaluated before using them as an effective screening tool.

Normal mean oral temperature is 98F, not 98.2F or 98.6F

Background 98.6F is generally accepted as normal body temperature as defined by Wunderlich (1868) and later challenged by Mackowiak (1992) and Protsiv (2020) who concluded as 98.2F based on cross-sectional studies. Hence, the normal body temperature at present needs quantification? Methods A longitudinal study on the healthy population of Northen-India were followed-up over 1-year. Participants were advised for self-monitoring of oral temperature with a standard digital thermometer in either left or right sublingual pocket and record it in the thermometry diary. The study was considered complete if the participant had all the three phases of the study (i.e. non-febrile, febrile, and post-febrile phases) or completed the duration of the study. Results The mean oral temperature of the participants (n=144) during the non-febrile and post-febrile phases (temperature readings=6543) were 98F (SD, 0.61) and 98.01F (SD, 0.60) respectively (P<0.001). The mean oral temperature during post-febrile phase was found to be 0.01F higher than non-febrile phase. With the diurnal variability, the morning (AM), noon (AN), and afternoon (PM) mean temperatures were 97.91, 98.08, and 98.27F (P<0.001) respectively during the non-febrile phase. Similar trends were observed in variability among men and women, and seasons. Conclusions The mean oral temperature is 98F (SD, 0.61). The temperature is as low as 96.9F and as high as 99.1F. The temperature during post-febrile phase was found to be higher than the non-febrile phase temperature like PM over AN & AM, women over men, summer over other seasons in the non-febrile phase, spring over others in the post-febrile phase.

Use of multiple anticholinergic medications can predispose patients to severe non-exertional hyperthermia

We present a case of a 64-year-old woman who developed severe non-exertional hyperthermia (NEHT) due to excessive anticholinergic effects from her psychiatric medications. The patient was found unresponsive in a non-air-conditioned room where the outside temperature was over 33°C. She presented with altered mental status, hypotension and an oral temperature of 42°C. Drug–drug interactions from her home medications for depression, bipolar disorder and seizures (amitriptyline, cyclobenzaprine, benztropine, topiramate, clonazepam, trazodone) were suspected. Blood cultures grew Staphylococcus hominis. The patient quickly returned to baseline with supportive care in the intensive care unit. She was treated for the Staph hominis bacteraemia with a 7-day course of vancomycin. Due to her quick recovery and lack of neurological findings, severe NEHT with associated bacteraemia was determined to have caused her presenting symptoms. This patient’s multiple anticholinergic medications increased her susceptibility to develop NEHT by inhibited sweating, this patient’s natural cooling mechanism.

One size does not fit all: Assuming the same normal body temperature for everyone is not justified

Despite the increasing personalization of medicine, surprisingly ~37.0°C (98.6°F) continues as the estimate of normal temperature. We investigated between-subject and within-subject thermal variability, whether a significant percentage of individuals have a low mean oral temperature, and whether these differ by sex, age, time of day, ethnicity, body mass index (BMI), or menstrual phase. Oral temperature was measured by Life Brand® Fast-Read Digital Oral Thermometers and sampled 14 times over two weeks, seven morning and seven evening readings. The volunteer sample consisted of 96 adults (42 men, 54 women; 27 couples, 42 singletons), ages 18–67 years. We found sizeable individual differences in body temperature and that the normal temperature of many individuals is considerably lower than 37.0°C (98.6°F). Mean temperatures ranged from 35.2°C (95.4°F) to 37.4°C (99.3°F). The mean temperature across all participants was 36.1°C (97.0°F)—lower than most studies have reported, consistent with recent evidence of temperature declining over decades. 77% had mean temperatures at least 0.55°C (1°F) lower than 37.0°C (98.6°F). Mean temperature did not differ by age, but women had higher temperatures than men, even within a couple with room temperature and warmth of clothing equated. Although oral temperature varied widely across individuals, it showed marked stability within individuals over days. Variability of temperature over days did not differ by sex, but was larger among younger adults. Using 37.0°C (98.6°F) as the assumed normal temperature for everyone can result in healthcare professionals failing to detect a serious fever in individuals with a low normal temperature or obtaining false negatives for those individuals when using temperature to screen for COVID-19, mistaking their elevated temperature as normal. Some have called for lowering the estimate of normal temperature slightly (e.g., 0.2°C [0.36°F]). That still seems an overly high estimate. More important, using any standardized “normal” temperature will lead to errors for many people. Individual differences are simply too great. Personalizing body temperature is needed. Temperature could be measured at yearly doctor visits, as blood pressure is now. That would be simple to implement. Since our results show marked thermal stability within an individual, sampling temperature only once yearly could provide an accurate indication of a person’s normal temperature at that time of day. Such records over time would also provide a more accurate understanding of how temperature changes over the lifespan.