Areas of academic research with the impact of COVID-19.

Coronavirus (COVID-19) endemic is growing exponentially in the whole world. Researchers, technologists, doctors and other healthcare workers are working day and night on the development of vaccine and medicinesto control and treat this virus. SARS-CoV-2 is the name of the virus responsible for causing COVID-19 disease, which is highly infectious and lethal.With exponentially increasing infections, proportionate fatalities are being reported both from developed and under developed countries. As of today, more than one million people across the world have been reported infected with this virus, and more than 65,000 people have died of this disease. Hence, there is an urgent requirement for conducting academic research on several aspects of this highly contagious disease, to find effective means of containment and treatment of the disease, for now, and in future. We have identified some opportunities for academic research related to COVID-19 and have also provided suggestions to contain, prevent and treat this viral infection.

Altersolanol A: a selective cytotoxic anthraquinone from a Phomopsis sp.

UNLABELLED: The cytotoxic compound Altersolanol A, an anthraquinone derivative was isolated from PM0409092 a fungus of Nyctanthes arbor-tristis (family Oleaceae). It was identified as a Phomopsis sp. by DNA amplification and sequencing of the ITS region. The chemical structure of Altersolanol A was elucidated from its physicochemical properties, 2D NMR spectroscopy and other spectroscopic data. The compound has in vitro cytotoxic activity against 34 human cancer cell lines with mean IC50 (IC70) values of 0.005 µg ml(-1) (0.024 µg ml(-1)) respectively. Altersolanol A, a kinase inhibitor, induces cell death by apoptosis through the cleavage by Caspase-3 and -9 and by decreased anti-apoptotic protein expression. There are several previous reports of the anticancer activity of Altersolanol A, but we report here an extensive study using 36 cell lines which gives wider spectrum of results. SIGNIFICANCE AND IMPACT OF THE STUDY: This study confirms the cytotoxic potential of Altersolanol A isolated from the endophyte Phomopsis sp. (PM0409092) of the plant Nyctanthes arbor-tristis. The compound exhibits in vitro cytotoxicity against 34 human cancer cell lines with mean IC50 (IC70) value of 0.005 µg ml(-1) (0.024 µg ml(-1)). This is an in-depth report of Altersolanol A against a panel of 34 human cancer cell lines and extends observations from previous studies indicating that Altersolanol A can be used for the development of chemotherapeutics. Altersolanol A, a kinase inhibitor, induces cell death by apoptosis through the cleavage of Caspase-3 and -9 and by decreased anti-apoptotic protein expression.

Implementation of the INTERGROWTH-21st Project in India.

The South Asian site in the INTERGROWTH-21(st) Project was the city of Nagpur, in Maharashtra State, India, with approximately 4500 births per year among the target population with middle to high socio-economic status. These deliveries are mainly concentrated in 20 small private hospitals, most of which are in the city centre. The sample for the Newborn Cross-Sectional Study (NCSS) was drawn from ten of these hospitals, covering 76% of the target low-risk pregnant population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from the largest of these institutions, Ketkar Hospital, as well as several ancillary antenatal care clinics. Special activities to encourage participation and raise awareness of the study at this site included translating patient information leaflets into local languages and securing local media interest. Among the unique challenges of the Indian site was the coordination of the large number of hospitals involved in NCSS, a task that required careful planning and organisation by the field teams.

Stability of a charged drop near a conductor wall.

The effect of conductor boundaries on the deformation and stability of a charged drop is presented. The motivation for such a study is the occurrence of a charged conductor drop near a conductor wall in experiments (Millikan-like set-up in studies on Rayleigh break-up) and applications (such as electrospraying, ink-jet printing and ion mass spectroscopy). In the present work, analytical (linear stability analysis (LSA)) and numerical methods (boundary element method (BEM)) are used to understand the instability. Two kinds of boundaries are studied: a spherical, conducting, grounded enclosure (similar to a spherical capacitor) and a planar conducting wall. The LSA of a charged drop placed at the center of a spherical cavity shows that the Rayleigh critical charge (corresponding to the most unstable l = 2 Legendre mode) is reduced as the non-dimensional distance ̂d = (b - a)/a decreases, where a and b are the radii of the drop and spherical cavity, respectively. The critical charge is independent of the assumptions of constant charge or constant potential conditions. The trans-critical bifurcation diagram, constructed using BEM, shows that the prolate shapes are subcritically unstable over a much wider range of charge as [Formula: see text] decreases. The study is then extended to the stability of a charged conductor drop near a flat conductor wall. Analytical theory for this case is difficult and the stability as well as the bifurcation diagram are constructed using BEM. Moreover, the induced charges in the conductor wall lead to attraction of the drop to the wall, thereby making it difficult to conduct a systematic analysis. The drop is therefore assumed to be held at its position by an external force such as the electric field. The case when the applied field is much smaller than the field due to inherent charge on the drop ((a(3)ρg)/(3ε(0)Ψ(2)) ≪ 1 is considered. The wall breaks the fore-aft symmetry in the problem, and equilibrium, predominantly prolate shapes corresponding to the legendre mode, l = 2 , are observed. The deformation increases with increasing charge on the drop. The breakup of the prolate equilibrium shapes is independent of the legendre modes of the initial perturbations. The prolate perturbations are subcritically unstable. Since the equilibrium prolate shapes cannot continuously exchange instability with equilibrium oblate shapes, an imperfect transcritical bifurcation is observed. A variety of highly deformed equilibrium oblate shapes are predicted by the BEM calculations.

Silver nanoparticles: the powerful nanoweapon against multidrug-resistant bacteria.

In the present scenario, pharmaceutical and biomedical sectors are facing the challenges of continuous increase in the multidrug-resistant (MDR) human pathogenic microbes. Re-emergence of MDR microbes is facilitated by drug and/or antibiotic resistance, which is acquired way of microbes for their survival and multiplication in uncomfortable environments. MDR bacterial infections lead to significant increase in mortality, morbidity and cost of prolonged treatments. Therefore, development, modification or searching the antimicrobial compounds having bactericidal potential against MDR bacteria is a priority area of research. Silver in the form of various compounds and bhasmas have been used in Ayurveda to treat several bacterial infections since time immemorial. As several pathogenic bacteria are developing antibiotic resistance, silver nanoparticles are the new hope to treat them. This review discusses the bactericidal potential of silver nanoparticles against the MDR bacteria. This multiactional nanoweapon can be used for the treatment and prevention of drug-resistant microbes.

Ipsilateral keratoconus associated with long-standing primary hydatid cyst of the orbit.

Hydatid cyst is a cyclozoonotic infection of the larvae form of a platyhelminthes Echinococcus granulosus. The majority of hydatid cysts appear in the liver (65%) and lungs (25%). Kidneys and brain are other less common sites for this disease. Only 1% to 2% cases are seen in the maxillofacial region. These commonly appear as cystic lesions located in the mandible, maxillary sinus, orbit, infratemporal fossa, pterygopalatine fossa, parapharyngeal space, tongue, and parotid and submandibular salivary gland. Hydatid cysts of the orbit are rare and account for 1% of all hydatid cysts. The article presents hydatid cyst of the orbit in a 10-year-old child. Clinical features, investigations, surgical approaches, and adjuvant medical management have been emphasized. We believe that the lateral orbital route allows excellent exposure and safe removal of an intraorbital hydatid cyst located posteriorly, superiorly, and laterally without damaging the surrounding important orbital structures. Upper blepharoplasty incision results in good cosmetic outcome.

Treatment of mixtures of toluene and n-propanol vapours in a compost-woodchip-based biofilter.

The present work describes the biofiltration of mixture of n-propanol (as a model hydrophilic volatile organic compound (VOC)) and toluene (as a model hydrophobic VOC) in a biofilter packed with a compost-woodchip mixture. Initially, the biofilter was fed with toluene vapours at loadings up to 175 g m(-3) h(-1) and removal efficiencies of 70%-99% were observed. The biofilter performance when removing mixtures of toluene and n-propanol reached elimination capacities of up to 67g(toluene) m(-3) h(-1) and 85 g(n-propanol) m(-3) h(-1) with removal efficiencies of 70%-100% for toluene and essentially 100% for n-propanol. The presence of high n-propanol loading negatively affected the toluene removal; however, n-propanol removal was not affected by the presence of toluene and was effectively removed in the biofilter despite high toluene loadings. A model for toluene and n-propanol biofiltration could predict the cross-inhibition effect of n-propanol on toluene removal.

Light-induced conformational changes in photosynthetic reaction centers: impact of detergents and lipids on the electronic structure of the primary electron donor.

Light-induced hypsochromic shifts of the Q(y) absorption band of the bacteriochlorophyll dimer (P) from 865 to 850 nm were identified using continuous illumination of dark-adapted reaction centers (RCs) from Rhodobacter capsulatus when dispersed in the most commonly used detergent, the zwitterionic lauryl N-dimethylamine-N-oxide. Such a shift is known to be the consequence of the decreased degree of delocalization of P. A 2-fold acceleration of the recovery kinetics of P(+) was found in RCs that underwent light-induced structural changes compared to those where the P-band position did not change. The light-induced shift was irreversible except in the presence of a secondary electron donor. Prolonged (15 min) illumination resulted in a shift in the position of the P-band even in neutral or negatively charged detergents. In contrast, RCs reconstituted into liposomes made from lipids with different headgroup charges showed light-induced shifts only if shorter fatty acid chains were used. The light-induced conformational changes caused a prominent decrease of the redox potential of P ranging from 120 to 160 mV depending on the detergent compared to the potential of P in dark-adapted reaction centers. The measured light-induced potential decreases were 55 to 85 mV larger than those reported for reaction centers where the P-band position remained at 865 nm. The influence of structural factors, such as the delocalization of the electron hole on P(+), the involvement of Tyr M210, and the hydrophobic mismatch between the thickness of the hydrophobic belt of the detergent micelles or the lipid bilayer and the RC protein, on the spectral features and electron transfer kinetics is discussed.

Congenital cystic adenomatoid malformation in an adolescent: an unusual presentation with pleural effusion and pneumatocele.

Congenital cystic adenomatoid malformation (CCAM) encompasses a continuum of hamartomatous cystic lung lesions characterised by the presence of abnormal bronchiolar structures of varying sizes or distribution. The CCAM is a disorder of infancy with majority of the cases being diagnosed within the first two years of life. We describe CCAM in a 13-year-old girl complaining of recurrent lower respiratory tract infections since infancy who presented with post-infectious pneumatocele with loculated pleural effusion, and suspected abscess formation and had undergone resection.

Unhealthy alcohol use independently associated with unfavorable TB treatment outcomes among Indian men.

BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak.METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints.RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4.CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.

Determination of water quality index by fuzzy logic approach: a case of ground water in an Indian town.

The paper proposes fuzzy logic model that deals with the physico-chemical water analysis of ground water of Chikhli town for determination of Water Quality Index (WQI). The study was carried by collection of ground water samples from about eleven hand pumps located in this town. Ground water quality is studied by systematic collection and analysis of samples. The fuzzy logic is used for the deciding the water quality index on the basis of which, water quality rankings are given to determine the quality of water. The Water Quality Index presented here is a unitless number ranging from 1 to 10. A higher number is indicative of better water quality. Around 81% of samples were found suitable for drinking purpose. It is also observed that all the parameters fall within the permissible limits laid by WHO, ISI, and ICMR, except Total Hardness, Calcium and Magnesium. The quality parameters were compared with standards laid by the World Health Organization (WHO), Indian Standards Institute (ISI) and Indian Council of Medical Research (ICMR) for drinking water quality.

Implant wastage in orthopaedic trauma: a UK experience.

INTRODUCTION: Implant wastage is an under-reported issue in orthopaedics, yet it has been shown to have a significant cost burden on healthcare budgets. In a background of a perilous financial climate in the UK health service, our aim was to define the frequency and costs of implant wastage in orthopaedic trauma. MATERIALS AND METHODS: The trauma theatre's implant logbook was retrospectively analysed between April 2017 and April 2018. Wasted implants were identified by the study authors independently. Patient demographics, implant details and costs were among the data collected. Product codes of wasted implants were used to identify implant costs through the manufacturer. RESULTS: Implant wastage occurred in 25.1% of trauma procedures during the study period. Most wasted implants (91%) were screws. The total cost of implant wastage was £8,377.25 during the 12-month period, accounting for 2% of the total implant budget. Wasted intramedullary nails accounted for almost 50% of the total cost. More than 51% of affected procedures involved a trainee as the primary operator. DISCUSSION: We report the first study of implant wastage in orthopaedics from the UK. Total implant wastage was higher than reported in most of the published literature, although it represented a small portion of the budget. Implant wastage is attributable to surgeons or operating theatre staff in most cases and is compounded by surgeons' limited understanding of implant costs. Initiatives to reduce implant wastage should include raising awareness of costs and departmental wastage to surgeons and operating theatre staff as well as employing preoperative planning techniques.

Assessment of the Xpert assay among adult pulmonary tuberculosis suspects with and without diabetes mellitus.

SETTING: Pune and Pimpri-Chinchwad Municipal Corporation area, Maharashtra State, India.OBJECTIVE: To assess the sensitivity and specificity of the Xpert® MTB/RIF assay among adults with suspected pulmonary tuberculosis (PTB) and with or without diabetes (DM).DESIGN: As part of a prospective cohort study, we screened 2359 adults presumed to have PTB with no history of TB. All individuals underwent testing for two sputum smears, culture, Xpert, glycated haemoglobin and fasting blood sugar. We calculated sensitivity and specificity of Xpert by comparing it with TB sputum culture result as a gold standard.RESULTS: Among screened individuals, 483 (20%) were diagnosed with DM and 1153 (49%) with pre-DM; 723 (31%) had no DM. Overall sensitivity of Xpert was 96% (95%CI 95-97) and specificity was 91% (95%CI 89-93). Xpert sensitivity was significantly higher among DM group (98%) than in the 'No DM' (95%; P < 0.01) and pre-DM (96%; P < 0.05) groups. Among sputum smear-negative individuals, Xpert sensitivity was higher in the DM group than in the No DM (92% vs. 82%; P = 0.054) and pre-DM group (92% vs. 82%; P = 0.037).CONCLUSION: High sensitivity and specificity of Xpert underscores the need for its rapid scale up for the early detection of TB in settings with a high dual burden of TB and DM.

Silver nanoparticles as an effective disinfectant: A review.

The paradigm modifications in the metallic crystals from bulky to micro-size to nano-scale have resulted in excellent and amazing properties; which have been the remarkable interests in a wider range of applications. Particularly, Ag NPs have much attention owing to their distinctive optical, chemical, electrical and catalytic properties that can be tuned with surface nature, size, shapes, etc. and hence these crystals have been used in various fields such as catalysis, sensor, electronic components, antimicrobial agents in the health industry etc. Among them, Ag NPs based disinfectants have paid attention due to the practical applications in our daily life. Therefore the Ag NPs have been used in different sectors such as silver-based air/water filters, textile, animal husbandry, biomedical and food packaging etc. In this review, the Ag NPs as a disinfectant in different sectors have been included in detail.

Buccal Fat Pad a Forgotten Option of Reconstruction in Oral Cancer.

The buccal fat pad (BFP) originally described as an anatomic structure without any obvious function. For long period it was considered to be surgical nuisance. However during the last four decades buccal fat is successively used tool for maxillofacial surgery for reconstruction of small to medium sized acquired or congenital soft tissue and bony defect in oral cavity. The aim of present article is to review the database available regarding BFP including its anatomy, clinical usage in oral malignancy as tool of reconstruction after ablative procedures it's success and its adoptability with other loco-regional flap for oral reconstruction in different scenario and our experience with it in tertiary cancer centre in India.

Population-based stroke survey in Mumbai, India: incidence and 28-day case fatality.

OBJECTIVES: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. BACKGROUND: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. METHODS: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. RESULTS: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 +/- (SD) 13.60 years, women were older as compared to men (mean age 68.9 +/- 13.12 years vs. 63.4 +/- 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. CONCLUSIONS: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary: outcomes and patterns of failure.

CONTEXT: Management of cervical lymph nodes metastases of squamous cell carcinoma (SCC) from primary of unknown origin (PUO) is contentious and there is insignificant data from India on this subject. AIMS: To present experience of management of these patients treated with curative intent at a single institution. SETTINGS AND DESIGN: Retrospective study of patients treated between 1989-1994 in a tertiary referral cancer centre. MATERIALS AND METHODS: Eighty-nine patients were evaluated in the study period and their survival compared with patients with common sites of primary in the head and neck with comparable node stage. STATISTICAL ANALYSIS USED: Kaplan-Meier method. RESULTS: The clinical stage of the neck nodes at presentation was N1 in 11%, N2a in 28.5%, N2b in 22.5%, N3 in 35% and Nx in 3.4% patients. All patients underwent surgery and 70 patients received more than 40Gy postoperative radiotherapy. Twenty-nine (32.6%) patients had relapse of which 19 (21%) were in the neck. Postoperative radiotherapy did not influence the neck relapse (p=0.72). Primary was detected in 13 patients (14.6%) on subsequent follow up. The overall five and eight-years survival was 55% and 51% respectively. The overall five-year survival was better compared to patients with known primary with comparable node stage. CONCLUSIONS: Patients with cervical lymph nodes metastases of SCC from PUO have reasonable survival and low rate of development of subsequent primary when treated with surgery and radiotherapy. The overall survival is comparable to that of patients with known primary and hence an attempt at cure should always be made.

Arterial hypoxemia in patients with cirrhosis of liver.

INTRODUCTION: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease. Development of hypoxemia in patients with chronic liver disease, modifies the line of management and worsens the prognosis of the disease. Hence an early detection of hypoxemia in these patients is essential. Hypoxemia results from various causes in patients with chronic liver disease. Hepato pulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Development of this complication in chronic liver disease indicates a poorer prognosis in these patients. Chronic liver disease is also known to be associated with pulmonary manifestations that affect both the pleural space and lung parenchyma. This study was undertaken to study the prevalence of hypoxemia and assess the prognosis in patients with chronic liver disease. MATERIALS AND METHODS: Fourty three patients aged 18 years and above with evidence of cirrhosis, admitted under the department of Medicine and Gastroenterology, were included in the study. A detailed history was taken and clinical examination were done in all patients. All patients underwent ultrasonography, LFT, biochemical tests and upper gastrointestinal endoscopy to confirm chronic liver disease, portal hypertension and varices, if any chest X-ray, 2-D transthoracic echocardiogram, viral studies and pulmonary function tests. The patients in whom arterial hypoxemia was detected with a positive contrast echocardiogram were considered to have hepato pulmonary syndrome. RESULTS: Six out of the 43 patients (13.9%) included in the study had hypo-xemia. Among these 6 patients with hypoxemia, 3 were found to have contrast enhanced echocardiographic evidence of intra pulmonary vascular dilatations and diagnosed hepato pulmonary syndrome. The other 3 patients had evidence of both, interstitial lung disease and pleural effusion contributing to hypoxemia. The patients with hepato pulmonary syndrome had a significant P (A-a) O2 gradient, died during the study period, indicating a poorer prognosis. CONCLUSIONS: We conclude that identification of hypoxemia and its aetiology in patients with chronic liver disease is essential. Identification of hepato pulmonary syndrome is important, as it carries a poor prognosis in patients with chronic liver disease.

Keratinophilic fungi from the vicinity of salt pan soils of Sambhar lake Rajasthan (India).

Forty soil samples were collected from seven sites in the vicinity of Sambhar lake Rajasthan, India and screened for the presence of keratinophilic fungi using hair baiting techniques for isolation. Seventeen isolates were recovered and identified. The cultures were identified by recognition of their macro- and micro- morphological features. Their identification was confirmed by BLAST using ITS1-5.8S-ITS2 rDNA region and sequences have been deposited in NCBI data base. A total of 34 species belonging to 29 genera were isolated. Among the dermatophytes and related keratinophilic fungi Chrysosporium indicum was predominant followed by Ctenomyces serratus, C. tropicum, Keratinophyton durus, Auxarthron conjugatum, Gymnascella dankaliensis, Gymnoascoideus petalosporus and Uncinocarpus reesii. Twenty-six species belonging to 22 genera represented other species. Our study indicates that keratinophilic fungi and species are found in the soils at the vicinity of the Sambhar Lake, and human activities can be the potential source of pathogenic fungi.

Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis.

Aims: The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI). Materials and Methods: Studies using alpha-defensin or Synovasure (Zimmer Biomet, Warsaw, Indiana) to diagnose PJI were identified from systematic searches of electronic databases. The quality of the studies was evaluated using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) tool. Meta-analysis was completed using a bivariate model. Results: A total of 11 eligible studies were included. The median QUADAS score was 13 (interquartile range 13 to 13) out of 14. Significant conflicts of interest were identified in five studies. The pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% confidence interval (CI) 0.91 to 0.98) and the pooled specificity was 0.97 (95% CI 0.95 to 0.98) for four studies with a threshold level of 5.2 mgl-1 The pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74 to 0.92) and the pooled specificity was 0.90 (95% CI 0.91 to 0.98). There was a statistically significant difference in sensitivity (p = 0.019), but not specificity (p = 0.47). Conclusion: Laboratory-based alpha-defensin testing remains a promising tool for diagnosing PJI. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are required before the widespread adoption of the lateral flow cassette alpha-defensin test. Cite this article: Bone Joint J 2018;100-B:703-11.