Clinical accuracy and agreement between tympanic and forehead body temperature measurements for screening of patients with COVID-19.

AIM: To investigate the accuracy, reliability and agreement between infrared forehead thermometers versus infrared tympanic thermometers temperature, a cross-sectional study was conducted in April 2020. METHODS: The forehead and tympanic temperatures of 615 subjects were measured simultaneously in three exposed SARS-COV-2 groups at one hospital in Iran, during April 2020. These comparisons were evaluated by Bland-Altman Plot, repeatability, Passing-Bablok regression and Lin's concordance correlation coefficient. The receiver operating characteristic (ROC) analysis was done to describe the discrimination accuracy of a diagnostic test. The study adhered to STROBE checklist for cross-sectional studies. RESULTS: A Bland-Altman plot indicated that the limits of agreement between the forehead and tympanic temperature were -0.259 to +0.19°C. Passing-Bablok regression analysis illustrated that the infrared forehead was not linearly related to tympanic temperatures (reference method), with a slope estimate that was significantly different from 1.00. The infrared forehead thermometer showed poor precision and lower accuracy than the tympanic. The forehead temperature readings had 60.0% sensitivity and 44.4% specificity (p > .05) to predict disease. CONCLUSION: According to the results of study, there is no evidence that the assessment of temperature by infrared forehead thermometer could discriminate between the two groups (positive and negative).

Point-of-care bedside gas analyzer: limited use of venous pCO2 in emergency patients.

BACKGROUND: Because arterial punctures are more painful, venous blood gas analysis has been proposed as an alternative. OBJECTIVES: To determine if venous pCO(2) can replace arterial pCO(2) in emergency patients using a bedside blood gas analyzer. METHODS: This is a cross-sectional study. We recruited patients who were deemed by the attending Emergency Physicians to require arterial blood gas analysis to determine their ventilation or acid-base status. A venous and an arterial blood gas sample were drawn from the patient, temporally as close to each other as possible. Both samples were then analyzed using the same bedside blood gas analyzer immediately after collection. RESULTS: There were 122 paired samples obtained. The strength of the association between arterial and venous pCO(2) is r = 0.838 (p = 0.001). The Bland-Altman bias plot methods for agreement show a mean difference of 3.3 mm Hg with two standard deviation limits of agreement being -17.4 to 23.9; 93.4% of the pCO(2) values fell within two standard deviation limits. Venous pCO(2) below 30 mm Hg had a 100% (95% confidence interval [CI] 90.5-100) sensitivity and 100% (95% CI 80.7-100) Negative predictive value to rule out hypercarbia, defined as arterial pCO(2) > 45 mm Hg. CONCLUSIONS: There is significant variability in the arteriovenous difference of pCO(2) readings, hence, arterial punctures are still needed to specifically determine the arterial pCO(2).

Socio-demographic profile and help-seeking behaviour of buprenorphine abusers in Singapore.

INTRODUCTION: The US Food and Drug Administration (FDA) approved buprenorphine or Subutex for the treatment of opiate dependence in October 2002. Buprenorphine is a partial agonist of the mu-opioid receptor; although initial animal research suggested a low abuse potential for buprenorphine, it was subsequently shown to have an abuse potential similar to that of morphine or hydromorphone. The objectives of this study were to establish the sociodemographic profile and help-seeking behaviour of buprenorphine abusers attending the deaddiction treatment clinics of the Community Addictions Management Programme. MATERIALS AND METHODS: One hundred and twenty subjects, all buprenorphine abusers fulfilling the diagnostic criteria for opiate dependence, who consented to the study, completed an interviewer-administered questionnaire. RESULTS: The mean age of those participating in the study was 39.2 [standard deviation (SD) 8.0] years. The majority of the participants were male (90%), 52.5% were currently employed and 98% had at least primary education. A family history of drug abuse was reported by 27% of the subjects. Illicit drug abuse occurred at an early age with mean age of onset of illicit drug abuse being 16.9 (SD 4.8) years with gateway drugs like marijuana and glue. CONCLUSIONS: It is vital for our medical profession to be aware of the trend in the local population to move from the abuse of illicit substances, to the abuse of prescriptive medications. It makes it necessary to increase the understanding of addictions both amongst our practising medical fraternity, and amongst those training to enter the profession. At the hospital level, it necessitates a higher level of vigilance among our emergency room physicians and those treating infectious diseases.

Circadian and ultradian (12 h) variations of skin blood flow and barrier function in non-irritated and irritated skin-effect of topical corticosteroids.

The skin is the organ that receives the greatest exposure to light and shows a high-amplitude circadian rhythm in epidermal cell proliferation. We have previously demonstrated that the skin barrier function has a significant circadian rhythm. Corticosteroids (CS) are the most commonly used topical treatment in dermatology. Time-dependent differences in their efficacy and side-effects would be of considerable interest. The aims of the current study were to examine time-dependent cycles in the effect of topical CS application in healthy and irritated skin on skin blood flow and its relationship to barrier function. Twenty clinically healthy, diurnally active subjects were examined at eight and nine time points over a 24 or 28 h span respectively, using non-invasive skin bioengineering techniques of laser Doppler imaging, a transepidermal water loss (TEWL) device and a skin thermometer in a 28 h session. The results of this current study demonstrate circadian and ultradian (12 h) variations in skin blood flow. A significant correlation was found between skin temperature and skin blood flow but not with TEWL. Circadian and ultradian rhythms are maintained during treatment with high-potency and mid-potency CS in healthy skin. These rhythms persist during stratum corneum disruption with and without CS application.

Socioeconomic profile of diabetic patients with and without foot problems.

INTRODUCTION: To identify the differences in a socioeconomic profile between two cohorts of diabetic patients - one with diabetic foot problems and another without diabetic foot problems. MATERIALS AND METHODS: The cohort with diabetic foot problems (including cellulitis, abscess, osteomyelitis, septic arthritis, gangrene, ulcers, or Charcot joint disease) consisted of 122 diabetic patients, while the other cohort without foot problems consisted of 112 diabetic patients. Both were seen at the National University Hospital from January to April 2007. A detailed protocol was designed and the factors studied included patient profile, average monthly household income, education, compliance to diabetic medication, attendance at clinics for diabetic treatment, exercise, smoking, alcohol consumption, gender, and glycosylated haemoglobin (HbA1(C)) level. These were studied for significant differences using univariate and stepwise multivariate logistic regression analysis. RESULTS: With multivariate analysis, Malay ethnicity (p<0.001), education of up to secondary school only (p=0.021), low average monthly household income of less than SGD $2,000 (p=0.030), lack of exercise (at least once a week, p=0.04), and elevated HbA1(C) level (>7.0%; p=0.015) were found to be significantly higher in the cohort with diabetic foot problems than the cohort without. CONCLUSIONS: There are significant differences in the socioeconomic factors between diabetic patients with diabetic foot problems and those without.