Thermographic measurement of skin temperature recovery time of extremities in patients with type 2 diabetes mellitus

Analysis of predictors of fever after aortic valve replacement: Diabetic patients are less likely to develop fever after aortic valve replacement, a single-centre retrospective study

BACKGROUND

Postoperative temperature dysregulation affects the length of hospital stay and prognosis. This study evaluated the factors that influence the occurrence of fever in patients after aortic valve replacement surgery.

METHODS

Eighty-seven consecutive patients who underwent aortic valve replacement surgery were included. Patients' age, sex and body mass index; presence of diabetes mellitus; operation time; blood loss; blood transfusion volume; preoperative and postoperative laboratory findings; presence or absence of oral function management; and fever >38°C were retrospectively analysed through univariate and multiple logistic regression analyses.

RESULTS

Among the variables, only diabetes mellitus status was significantly associated with fever ⩾38°C. Postoperatively, patients with diabetes mellitus were significantly less likely to develop fever above 38°C and a fever rising to 38°C.

CONCLUSIONS

This study shows that the presence of comorbid diabetes mellitus decreases the frequency of developing fever >38°C after aortic valve replacement surgery.

Immediate Effect of Whole-Body Vibration on Skin Temperature and Lower-Limb Blood Flow in Older Adults with Type 2 Diabetes: Pilot Study

The purpose of this study was to evaluate the response of a single whole-body vibration (WBV) training session to peripheral skin temperature and peripheral blood flow of older adults with type 2 diabetes. A double-blind, controlled clinical trial was conducted following the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A single session of WBV (24 Hz; amplitude 4 mm; vibration time 45 s, with a series of eight repetitions with recovery between repetitions of 30 s; total time of 10 min) or sham vibration on the Kikos P204 Vibrating Platform was employed. To assess skin temperature, the FLIR E40bxs thermographic camera and the ultrasonic vascular Doppler for flow velocity were used. Evaluation occurred before and after a WBV or sham intervention. The sample consisted of three men and 17 women. In the WBV group, there was a decrease in the temperature from 29.7 °C (±1.83) to 26.6 °C (±2.27), with p = 0.01. Temperature following sham decreased from 28.6 °C (±1.84) to 26.3 °C (±2.49), with p = 0.01. Regarding blood flow, there was a decrease in the analyzed arteries, especially the left posterior tibial artery, where there was a statistically significant flow reduction from 27.1 m/s (±25.36) to 20.5 m/s (±19.66), post WBV (p = 0.01). In the sham group, an increased flow velocity was observed for all the arteries analyzed, except for the left dorsal artery. Immediately following a full-body vibration session, peripheral skin temperature and lower-limb blood flow tend to decrease in diabetic patients. However, from the design of study developed, we cannot infer the maintenance of this effect in the medium and long term.

Investigation of scleral thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration using pig eyes

PURPOSE

The purpose of this study was to investigate the thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration (PPPEA) using pig eyes.

METHOD

Using a 20-gauge (G) vitrectomy system (Accurus^®, Fragmatome; Alcon Laboratories) in both the 'open-tip' and 'closed-tip' techniques, PPPEA was performed in pig eyes and the subsequent thermal injuries generated around the scleral wound were measured by infrared thermal imaging (thermography). Post surgery, the state of the scleral wound was observed under a microscope, and a tissue slice containing the scleral wound was then prepared and observed under an optical microscope.

RESULTS

Thermography measurements revealed a slight temperature rise around the scleral wound in the open-tip case, yet a marked temperature rise in the closed-tip case. The scleral wound incision produced by the open tip was linear, while that produced by the closed tip was expanded. Histological examination revealed mild degeneration of the sclera around the wound in the open-tip case, yet marked tissue degeneration by thermal injuries in the closed-tip case.

CONCLUSION

Our findings showed that in PPPEA, the temperature of the tip of a 20G vitrectomy system rapidly increases due to the closed-tip technique, thus producing obvious thermal damage to the scleral wound. In order to prevent thermal injuries to the scleral wound during PPPEA, it is important to shorten the time of ultrasonic oscillation during surgery as much as possible while the tip is occluded with nuclear fragments.

Computer aided diagnosis of diabetic foot using infrared thermography: A review

Diabetes mellitus (DM) is a chronic metabolic disorder that requires regular medical care to prevent severe complications. The elevated blood glucose level affects the eyes, blood vessels, nerves, heart, and kidneys after the onset. The affected blood vessels (usually due to atherosclerosis) may lead to insufficient blood circulation particularly in the lower extremities and nerve damage (neuropathy), which can result in serious foot complications. Hence, an early detection and treatment can prevent foot complications such as ulcerations and amputations. Clinicians often assess the diabetic foot for sensory deficits with clinical tools, and the resulting foot severity is often manually evaluated. The infrared thermography is a fast, nonintrusive and non-contact method which allows the visualization of foot plantar temperature distribution. Several studies have proposed infrared thermography-based computer aided diagnosis (CAD) methods for diabetic foot. Among them, the asymmetric temperature analysis method is more superior, as it is easy to implement, and yielded satisfactory results in most of the studies. In this paper, the diabetic foot, its pathophysiology, conventional assessments methods, infrared thermography and the different infrared thermography-based CAD analysis methods are reviewed.

Application of infrared thermography in computer aided diagnosis

The invention of thermography, in the 1950s, posed a formidable problem to the research community: What is the relationship between disease and heat radiation captured with Infrared (IR) cameras? The research community responded with a continuous effort to find this crucial relationship. This effort was aided by advances in processing techniques, improved sensitivity and spatial resolution of thermal sensors. However, despite this progress fundamental issues with this imaging modality still remain. The main problem is that the link between disease and heat radiation is complex and in many cases even non-linear. Furthermore, the change in heat radiation as well as the change in radiation pattern, which indicate disease, is minute. On a technical level, this poses high requirements on image capturing and processing. On a more abstract level, these problems lead to inter-observer variability and on an even more abstract level they lead to a lack of trust in this imaging modality. In this review, we adopt the position that these problems can only be solved through a strict application of scientific principles and objective performance assessment. Computing machinery is inherently objective; this helps us to apply scientific principles in a transparent way and to assess the performance results. As a consequence, we aim to promote thermography based Computer-Aided Diagnosis (CAD) systems. Another benefit of CAD systems comes from the fact that the diagnostic accuracy is linked to the capability of the computing machinery and, in general, computers become ever more potent. We predict that a pervasive application of computers and networking technology in medicine will help us to overcome the shortcomings of any single imaging modality and this will pave the way for integrated health care systems which maximize the quality of patient care.

Stress-induced hyperviscosity in the pathophysiology of takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TC) is characterized by transient hypokinesis of the left ventricular apex or midventricular segments with coronary arteries without significant stenosis. It is often associated with emotional or physical stress; however, its pathophysiology is still unclear. In the present study, we analyzed the alterations in blood viscosity and markers of endothelial damage induced by sympathetic stimulation in patients with previous TC. Seventeen women (mean age 71 years) with previous TC, included and investigated in the TC Tuscany Registry, were compared to a control group of 8 age- and risk factor-matched women with chest pain and coronary arteries free of stenosis. All subjects underwent the cold pressor test (CPT). Before and after the CPT, the hemorheologic parameters (whole blood viscosity at 0.512 s(-1) and 94.5 s(-1), plasma viscosity, erythrocyte deformability index, and erythrocyte aggregation), catecholamines, plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor levels were assessed. The patients with TC had significantly greater baseline PAI-1 levels (p <0.01) and lower erythrocyte deformability index values (p <0.01). After CPT, both the patients with TC and the controls had a significant increase in several hemorheologic parameters, catecholamines, and von Willebrand factor levels and a decrease in erythrocyte deformability index. However, the PAI-1 levels were significantly increased only in the patients with TC. Compared to the controls, the patients with TC had significantly greater values of whole blood viscosity at 94.5 s(-1) (p <0.05), PAI-1 (p <0.01), von Willebrand factor (p <0.05) and lower erythrocyte deformability index values (p <0.01) after CPT. In conclusion, the results of the present study suggest that in patients with TC, the alterations in erythrocyte membranes and endothelial integrity induced by catecholaminergic storm could determine microvascular hypoperfusion, possibly favoring the occurrence of left ventricular ballooning.

Geoenvironmental diabetology

Many reports have documented the negative health consequences that environmental stressors can have on patients with diabetes. Studies examining the interaction between the environment and a patient with diabetes can be unified under a single discipline termed "geoenvironmental diabetology." Geoenvironmental diabetology is defined more specifically as the study of how geophysical phenomena impact a patient with diabetes, to include effects on metabolic control, ancillary equipment (e.g., glucometers and insulin pumps), medications, supplies, access to care, and influences on the adaptive strategies employed by patients to care for their diabetes under extreme circumstances. Geological events such as natural disasters (e.g., earthquakes) or extreme weather (e.g., heat waves) are examples of stressors that can affect patients with diabetes and that can be included under the heading of geoenvironmental diabetology. As proposed here, geoenvironmental diabetology refers to how events in the physical world affect those with diagnosed diabetes, rather than how environmental factors might trigger development of disease. As the global prevalence of diabetes continues to increase, including in parts of the world that are especially vulnerable to disasters and climate change, further discussion is warranted on how to best prepare for management of diabetes under conditions of extreme geological and weather events and a changing climate. An overview is presented of various studies that have detailed how geoenvironmental phenomena can adversely affect patients with diabetes and concludes with a discussion of requirements for developing strategies for geoenvironmental diabetes management.

Use of a temperature gradient measuring device in monitoring of diabetic and critically ill patients

A device realizing the simultaneous measure of the central body temperature (Tc), the superficial one (Ts) and their difference (Dt), was proposed for permanent energetic balance evaluation in humans. A program was elaborated to command the intravenous delivery of insulin by a pump depending on the value and trends of Dt. The use of this device for monitoring of decompensated diabetic patients allowed their easier stabilization. In critically ill patients (post transplantation, myocardium infarction) it had a diagnostic and prognostic value, and was helpful for optimization of conventional and insulin therapy.

Are Infrared and Thermistor Thermometers Interchangeable for Measuring Localized Skin Temperature?

Localized skin temperature must be measured by accurate and reliable thermometers to effectively evaluate treatment outcomes, monitor changes, and predict potential complications. This study compared localized skin temperature measurements with a contact thermistor thermometer used as a reference standard and a noncontact infrared (IR) skin thermometer to determine their interchangeability with calculated Bland-Altman limits of agreement. Fifty-five adults ages 50 to 89 participated in the study in which data were collected in a climate-controlled room over 3 measurement periods, 1 week apart. The thermistor and IR thermometers were interchangeable with a limit of agreement of ± 1.5°C. This limit of agreement is acceptable as a reference standard for IR thermometers to measure localized skin temperature in clinical settings.