Evaluation of Infrared Thermometer on Human Health – A Review
1Department of Pharmacology, University Institute of Pharmaceutical Sciences (UIPS),
Chandigarh - Punjabi, India.
2Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research
(JSS AHER), Mysuru, Karnataka, India.
*Corresponding Author E-mail: seemamehdi@jssuni.edu.in
ABSTRACT:
Several public and private working areas at exit or entry zone practices temperature screening for both clients and workers, this process is performed with the help of infrared thermometers to measure possible related symptoms of coronavirus disease 2019 (COVID-19). There are numerous studies that explained pandemic diseases based on different angles including the spread pattern of the disease, mortality rate, approaches taken as preventive measures, clinical measures, and so on. One of the preventive measures practiced is to screen the body temperature of individuals in order to identify if there are any possible symptoms of covid-19 such as fever. This modality of screening temperature mostly uses an infrared thermometer. This review article will be going to explain the screening of body temperature by using non-contact hand held thermometers, the accuracy of measurement, the types of radiation used by these thermometers, and the possible biological effects of being exposed to radiation on daily basis.
KEYWORDS: Coronavirus disease 2019 (COVID-19), Infrared radiation, Temperature, Thermometer.
INTRODUCTION:
The coronavirus disease 2019 (COVID-19) is a contagious disease caused by a novel coronavirus 2 (SARS-CoV-2) virus strain. Patients infected with the virus develop mild to severe respiratory disease. The COVID-19 virus is spread mostly by droplets of saliva or nasal discharge when an infected person coughs or sneezes. Among the symptoms of Covid-19 include fever, temperature rises (>38oC)1,2 and other clinical presentations related to pulmonary pathology3, and haematological features (Frater, Zini, d’Onofrio, and Rogers, 2020). Normally, the body temperature of a human being is controlled within a certain range of 36°C and 38°C despite climate temperature variations. Parts of the body like the hypothalamus, spinal cord, skin, and other organs have thermoreceptors that monitor changes in temperature by autonomic mechanisms which either lead to preserving heat (through shivering and constriction of blood vessels) or losing heat (through sweating and dilation of blood vessels)4.
In 2003, severe acute respiratory syndrome (SARS), was widespread in Asia and give rise to fear in several nations. IRT is a quick-finding technique and the utmost frequently used to screen the temperature of the tympanic and the forehead. The tympanic temperature is closest to the core body temperature and offers the most reliable data. In 2014, a non-contact thermometer was used to screen passengers for symptoms of Ebola infection at 5 airports in the United States5. Hence, body temperature is an extremely significant factor and vital sign considered by medical professionals in the diagnosis of various diseases, as well as in public health scenarios and management6. The need for a comprehensive screening programmed to identify individuals who could be infected with the novel coronavirus COVID-19 has been highlighted7.
The common methods used for measuring body temperature is beginning with conductive and infrared devices, which work by different principles of thermal heat transfer. Various thermometers that need skin contact to detect body temperature, such as mercury thermometers, have been considered useful in some situations while simultaneously posing a risk of spreading illnesses in others. Apart from that, there are non-contact thermometers like a hand-held infrared thermometer which uses infrared light to screen the body temperature of an individual without any physical contact8. Handheld forehead infrared thermometers (IRTs) are used in the screening process for coronavirus (COVID-19), SARS, cases of flu, and other viruses. This IRT was designed to calculate the temperature of the wrists and the temperature of the forehead. The effect of an item's superficial emissivity on the temperature determined by an IRT is the most important. The tympanic membrane emissivity is believed to be 1.0, while the human skin emissivity varies between 0.976 and 0.9849.
The accuracy of measurement obtained via non-contact thermometers is doubtful. Some experiments were conducted to compare the measuring values obtained by an infrared thermometer that was not in touch and other thermometer types, and it was concluded that the non-contact infrared thermometer was weakly conforming to it. The study found that temperatures measured by different thermometers had a poor agreement (i.e., low validity)10,11 because of various variables such as environmental factors such as solar radiation and wind speed12. Even though the hand-held infra-red thermometer is extensively used to monitor great cohorts as it is moveable, doesn’t involve physical contact, and fewer worries to the person being measured, but still no sufficient statistics to support its use. The bulk of the inaccuracies and the medicinal norms for temperature estimation and fever diagnosis is measured by non-released infrared thermometers compared with the International Temperature Scale of 1990 (ITS-90)13,14.
Despite the changes in scientific principles of working for each technique of measuring temperature, several scientists and experts accept interchangeability among devices in all situations. Present practices recommend that for ay device used the localized skin temperature, the mean difference (MD) of ± 0.5°C and the compromise limits must not be exceeded clinically by ±1.0°C (Bach et al., 2015). Hsuan-Yu Chen in a study involved 659 citizens found that the value of Coefficient of variance (CV) is less than 1.0% for tympanic temperature, 1.129% for forehead, and 1.332% for wrist temperature. Good precision is indicated when a CV of 5%. (table 1) below represent the results generally. This implies that the screening of temperature by using an infrared thermometer is uncertain.
Table 1: The test results were observed employing a BRAUN infrared thermometer
|
Description |
Left-Ear |
Right-Ear |
Fore head |
Wrist |
Average values of both Ears |
|
Mean |
36.904 |
36.912 |
34.714 |
34.1644 |
36.911 |
|
Standard Deviation (σ) |
0.286 |
0.259 |
0.392 |
0.455 |
0.264 |
|
Coefficient of Variance (%) |
0.775 |
0.712 |
1.129 |
1.332 |
|
|
Minimum |
35.8 |
35.9 |
34.0 |
34.0 |
35.85 |
|
Maximum |
37.5 |
37.8 |
37.3 |
36.1 |
37.7 |
The range of infra-red radiations is found between microwaves and visible light on the electromagnetic spectrum. (table 2) below represent the infrared radiations16-17.
Table 2: The table below represents the infrared radiations
|
IR Region |
Wavelength (µm) |
Wavenumber (cm-1) |
|
1) Near IR (closest to visible light region) |
1.2 – 2.5 |
14,000 – 4,000 |
|
2) Mid IR |
2.5 – 25 |
4000 – 400 |
|
3) Far IR (closer to microwave region) |
25 – 400 |
400 – 10 |
|
Mid IR Region subdivided into the following |
||
|
Functional group region |
2.5 to 8.0µm |
4000-1300 cm–1 |
|
Fingerprint region |
8.0 to 25µm |
1300-400cm-1 |
Generally, the infra-red radiations have both advantages18 and shortcomings19-21. The sunshine that spread comprises solar energy collected of 6.8% ultraviolet, 38.9%, and 54.3% for visible light and infrared radiation respectively. Apart from the natural near-infrared, the skin of humans is progressively unprotected from artificial near-infrared light from therapeutic and medical techniques22. Normally, the skin is laid open to various exterior aspects that distress its condition. For instance, skin may respond to sunlight, climate change, variation of temperature and moisture. The light can be diffused, reflected by superficial layer, dispersed by components of skin, or undergo chromophore absorption. The process of absorption based on incident light wavelength and type of chromophore. Light which ranges on region of (600-1200 nm) is mainly absorbed by components of tissues like amino acids, lipids, water and nucleic acids23-25.
A current study exposed that FIR recovers mitochondrial function in neuroblastoma cells. Mitochondria is a core part for numerous functions of the cells involving generation of energy, calcium signaling, growth and death of the cell. Far-infrared (FIR) radiation has a large number of beneficial impacts on cell health and physiology. The parameters for the non-thermal biological effects of FIR are not measured by a proper method which restricts their biomedical application26. Near infrared radiations are frequently used in various therapies and recognized to give therapeutic aids. Still, new scientific studies shows that though infrared is helpful in some cases, but also harmful to human. The hemoglobin, myoglobin and water are absorbing the near IR because it is an electromagnetic wave with features of waves and particles. Near IR will then penetrate the skin with its wavelength and particle properties, disturbing subcutaneous tissues, including muscles and bone marrow Several public and private working areas at exit or entry zone practices temperature screening for both clients and workers, this process performed with the help of infrared thermometers to measure possible related symptoms of coronavirus disease 2019 (COVID-19). Due to that, there is a need of studies which will evaluate in deep on the infrared thermometers in human health27.
NIR looks to employ biological effects on skin of human being. Thin melanin and thin dermis skin enable NIR radiation to enter into human tissue deeper than dense melanin and thick dermis skin. NIR irradiation have the ability to stimulate mitogen-activated protein kinases and bring transcription process of gene and is probable rise the degradation of collagen. The NIR tempts photo-aging and possibly photo-carcinogenesis like to that of UV radiation28-32. In recent years, photo dermatological investigation helped in providing knowledge of molecular pathways that serve as the basis for the positive and the negative effects of human skin as a reaction to IR exposure. Since human skin is constantly exposed to ambient IR radiation, this power can induce the formation of free radicals or ROS indirectly or directly. A short explosion of IR-induced ROS has been observed by several researchers to be helpful for photogeneration33.
Nevertheless, free radicals and ROS caused by IR can be double-edged, they may activate defensive responses in low doses, but at high doses ROS may kill the cells in the skin which may lead to photoaging. Many experiments have shown that photoaging and photo-carcinogenesis of human skin involves IR radiation of 760~1000 nm. The IR-radiation mechanism which damages the skin is based on a matrix metalloproteinase-1 upregulation (MMP-1), which is triggered by p38-MAPK pathway activation and kinase 1/2(ERK1/2) signaling pathways controlled by the extracellular signals in response to IR radiation. When human skin is exposed to radiation of IR by single or multiple weekly, they might lead to various types of I procollagen expression and increased expression of the transformed growth factor beta (TGF-β), this is a family of β1, β2 and β3 cytokines which is known with multi- functionals such as cellular activity regulation34. The summary of the mechanism address in the (figure 1) below:
Figure 1: Represent the mechanism of Infrared when enter into the body
When Infrared radiation enters the body and interrupts the calcium signaling system may lead to various unwanted effects like cell death. Intracellular Ca2+ is a major second messenger for a variety of biological processes, such as smooth muscle contraction, neurotransmitter discharge, and signal pathway control. In the neonatal rat ventricular cardiomyocytes with which a pulses frequency of cells has been developed by a rapid increase in intra-cellular calcium following exposure to IR radiation (1862nm). The fluorescence measurement could be used to induce both IR-evoked and random events of calcium with 1862nm IR pulses (0.2 1 Hz). The induced events of calcium had a lower amplitude and shorter periods in comparison with unprompted events of calcium. An inhibitor of mitochondrial Ca2+ was used, which confirmed the theory that the mitochondrial Na+/Ca2+ interchangeable and mitochondrial Ca2+ uniporter regulated Calcium in mitochondria.
So, exposure to IR might cause apoptosis, as well addressed in the review talk about the function of Ca2+ in apoptosis, which is that depletion of Endoplasmic Reticulum (ER) Ca2+ or continued increase in cytosolic or mitochondrial concentration of Ca2+ is necessary to induce apoptosis8. The primary Ca2+ input contributing to cellular death is Store Operated Channel (SOC). In cytosol, apoptosis can be caused directly by the Ca2+ when activating calpain. In endoplasmic region (ER), the depletion of Ca2+ influences BAX/BAK interacts with the ER membrane protein (BCl-2), which support efflux of Ca2+ via IP3-R. As a result, the calpain and calcineurin can be amplified with this IP3-R Ca2+ efflux. The amplification of calcineurin will lead to BAD dephosphorylation and mitochondrial translocations. Mitochondria, which being overloaded with excessive Ca2+ reuptake also noted as induction of cell death. The Mitochondrial permeability transition pore (PTP) show close relationship with Cytochrome C and apoptotic inducing factor (AIF)8. The (figure 2) below give the demonstrative mechanism of cell death.
Figure 2: Calcium signalling induces Apoptosis
Radiation can destroy cells by two different pathways. Firstly, apoptosis (programmed cell death) or interphase death occurs without interfering with mitosis. They share a number of different morphological modifications, including loss of the natural nuclear structure and DNA degradation. Secondly, radiation-induced reproduction loss, by sufficient doses of radiation mitosis can be inhibited. Radiation destroys most mammalian cells by this mechanism of suppressing cellular proliferation15. The study showed that water occurs as a more
chemically/biologically target substances in various positions in cells. The most intracellular water is complex and has an orderly design to sustain biological system cellular processes. As water is absorbed primarily from the IR field, the absorption of photons will lead to a rapid rise in the intracellular temperature that can lead to undesirable physiological changes in osmosis, temperature, pH, and ATP rates. The following (figure 3) elaborate on the effects of radiation to the cells.
Figure 3: Represent Effects of radiations on mammalian cells
The comparison of different cell lines at different doses leads to a landscape where irradiation exaggerates the metabolism of ordinary cells at all doses, although cancer cells tend to be dose-dependent with biochemical modifications, and the trend does not shift to non-viable cells when the cell pattern increased. However, this dosage must also affect the metabolism of the normal cells. It must be taken into account1. There are two forms of health effects caused by radiation: acute and late-onset disease. Acute disease is the deterministic result of exposure above a threshold that shows the signs. A reduction of lymphocytes begins clinical symptoms of acute illness, followed by symptoms such as alopecia, cutaneous erythema, hematopoietic injury, gastrointestinal effect, and nervous system effects with increasing dosage. For the delayed onset of an illness, among complications, such as cancer, both non-cancer and genetic effects. Generally, it can be noted that the biological effects of radiation are dose-dependent to both normal and cancer cells. Due to that, repetitive usage of infrared thermometers to screen body temperature led to dose repetition even though in a small amount but in long run it might cause acute and/or late-onset diseases. This is another area which requires full research to reveal those possible negative health outcomes from infrared thermometers16.
The water molecule, hemoglobin and myoglobin have a tendency of absorbing NIR. Because of the O-H intramolecular hydrogen bonds and electrical dipole moment, a water molecule can resonate with NIR and absorb it, potentially changing its structure35. The oxygen-carrying proteins haemoglobin and myoglobin have multiple α helices in common. NIR is thought to cause helical resonance in oxygen-carrying proteins and the degeneration of proteins with helices, as a result, oxygen storage and transportation are harmed. This may be one of the apoptosis pathways36.
Similarly, DNA is made up of two long strands that form a double helix and are held together by two forces: hydrogen bonding between nucleotides and aromatic base stacking interactions. Varied experiments have been carried out using NIR spectroscopy in the context of DNA and cancer imaging because biological molecules including proteins, lipids and nucleic acids have a special spectral absorption pattern and NIR causes the vibration of DNA. Radiation by IR alone seems to cause breakages in the range of DNA and apoptosis37-39.
Generally, the infra-red radiations have both advantages and shortcomings. Near-infrared radiations are frequently used in various therapies and are recognized to give therapeutic benefits. But also, there is a possibility of getting negative outcomes from radiations like photoaging and photo-carcinogenesis of human skin, stimulating mitogen-activated protein kinases and bringing transcription process of gene and is probable rise the degradation of collagen; furthermore, the degeneration of proteins with helices, as a result, oxygen storage and transportation are harmed. The repetitive usage of infrared thermometers to screen body temperature led to dose repetition even though in a small amount but in long run it might cause acute and/or late-onset diseases. Hence, this is another area which requires full research to reveal those possible negative health outcomes from infrared thermometers used to screen body temperature.
The authors have no conflicts of interest.
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Received on 12.07.2022 Modified on 26.08.2022
Accepted on 14.10.2022 © RJPT All right reserved
Research J. Pharm. and Tech 2023; 16(9):4479-4484.
DOI: 10.52711/0974-360X.2023.00730