Background and objectives Previous studies have focused on the effect of kangaroo mother care (KMC) on stress among stable infants. Evidence regarding continuous zero-separation care among sick preterm infants remains limited. We hypothesised that keeping sick preterm infants with mothers in mother-newborn care unit (MNCU) with zero-separation would result in less stress and better growth as compared to inmates of conventional neonatal intensive care unit (NICU). Methods This cohort study enrolled preterm infants admitted to either MNCU or NICU. The assignment of infants in both the groups was non-random and based on bed availability. Preterm infants were admitted to MNCU if bed was available. Once all beds were occupied, infants were admitted in NICU. Stress was assessed using salivary cortisol and preterm infant pain profile (PIPP) scores. Growth parameters including body weight, length and head circumference were measured at birth and at discharge. Results 180 preterm (90 from each MNCU and NICU group) infants were enrolled in the study. MNCU infants showed a significant reduction in cortisol levels (-0.2±0.4µg/dL), whereas those in the NICU group showed an increase (+0.43±0.3 µg/dL); indicating significantly lower stress among MNCU group (P<0.001). Mean PIPP scores were significantly lower in the MNCU group as compared to NICU group (6.7±2.5 vs. 12.68 ± 2.03; P<0.001). Growth variables were significantly better in MNCU as compared to NICU, with higher daily weight gain (19.7±11.08 vs. 8.3±6.6 g/day; P<0.001), length gain (0.11±0.08 vs. 0.08±0.09 cm/day; P=0.003), and head circumference gain (0.11±0.10 vs. 0.03±0.05 cm/day; P<0.001). Interpretations and conclusions Zero-separation in MNCU is associated with reduced stress and better growth as compared to those admitted in NICU.
Background and objectives Carbapenem-resistant gram-negative pathogens are associated with limited treatment options and poor clinical outcomes. This study assessed the prevalence, distribution, antimicrobial susceptibility, and clinical outcomes of multidrug-resistant organisms from intensive care units and related wards in a South Indian tertiary care hospital over three years. Methods A retrospective laboratory-based study was conducted between October 2022 to May 2025, analysed culture-positive specimens from the selected locations using hospital information system data. Multidrug-resistant organisms were defined according to international criteria. Organisms included carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., and trimethoprim-sulfamethoxazole resistant Stenotrophomonas maltophilia. Demographics, specimen distribution, antimicrobial susceptibility, and outcomes were analysed using descriptive and inferential statistics. Results Of 8,704 specimens processed, 3,450 (39.6%) were culture-positive and 750 (34.2%) were multidrug-resistant. Carbapenem-resistant Enterobacterales accounted for (n=490,65.3%) of multidrug-resistant organisms, followed by carbapenem-resistant Acinetobacter baumannii (n=85,11.3%), carbapenem-resistant Pseudomonas aeruginosa (n=85,11.3%), methicillin-resistant Staphylococcus aureus (n=40,5.3%), vancomycin-resistant Enterococcus spp. (n=34,4.5%), and trimethoprim-sulfamethoxazole-resistant S. maltophilia (n=16,2.1%). Klebsiella pneumoniae predominated among carbapenem-resistant Enterobacterales isolates. Multidrug-resistant organisms were significantly more common in intensive care units (539/750,71.9%) and among patients aged >60 y (399/750,53.2%) (P<0.05). Enterobacterales showed high resistance to cephalosporins and fluoroquinolones, while A. baumannii demonstrated limited meropenem susceptibility (18/110,16.3%). Overall mortality among patients with multidrug-resistant infections was (191/750,25.5%), with 94% (180/191) of deaths clinically attributed to infection. Interpretation and conclusions Carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii are the predominant multidrug-resistant organisms, especially in intensive care units. These highlights the urgent need for strengthened antimicrobial stewardship, infection-control practices and ongoing antimicrobial resistance surveillance.
Background and objectives The advancement of 5G technology is highly anticipated due to its faster data transmission, yet its potential impact on male fertility remains unclear. This study evaluated the effects of 5G frequencies at 3.5 GHz and 24 GHz on sperm parameters, mating success, and offspring outcomes. Methods A total of 18 male Sprague Dawley rats (n=18) were divided into three groups: a Control group, a 3.5 GHz group, and a 24 GHz group (n=6). The Control group was sham-exposed. In contrast, the 3.5 GHz and 24 GHz groups were exposed to their respective frequencies for 7 h daily over 60 d. Following 46 d of exposure, a 1:1 mating procedure was conducted. Female rats (n=18) were monitored until gestation d 28 to assess pregnancy rates and birth metrics. Later, the male rats were sacrificed, and sperm quality was evaluated. Results Both exposed groups exhibited a significant decrease in sperm concentration and motility (P<0.001) compared to the Control group. The 24 GHz group had a lower pregnancy rate, whereas the 3.5 GHz group showed a lower live birth rate. Congenital anomalies were observed in the 3.5 GHz group, whereas the 24 GHz group presented significantly lower birth weights (P< 0.001). Interpretation and conclusions The findings suggest prolonged exposure to 5G frequencies may have a negative impact on male fertility, pregnancy outcomes, and the birth metrics.
Background and objectives Prehospital delay is a significant challenge in stroke management. Our study aims to identify factors associated with prehospital delay in stroke. Methods This cross-sectional study was conducted between March 2024 and May 2024 across thirteen hospitals in West Bengal, India. Patients with acute stroke (both ischaemic and haemorrhagic) aged 18 year or above who consented to participate were consecutively surveyed using a structured questionnaire. Arrival at the study hospitals more than 4.5 h after symptom onset was considered as prehospital delay. Results Out of 683 patients with stroke, 389 (56.9%) arrived more than 4.5 h after symptom onset. Factors linked to delayed arrival included: distance over 15 km [Adjusted Odds Ratio (aOR) 2.55, 95% Confidence interval (CI) 1.56-4.16], lack of awareness about the 'golden hour of stroke' (aOR 11.01, 95% CI 4.29-28.26), nighttime onset (aOR 1.81, 95% CI 1.16-2.82), being alone at symptom onset (aOR 11.33, 95% CI 4.65-27.59), wake-up stroke (aOR 2.06, 95% CI 1.15-3.67), use of public transport (aOR 3.05, 95% CI 1.42-6.55), family history of stroke (aOR 2.01, 95% CI 1.11-3.61), vertigo (aOR 2.3, 95% CI 1.03-5.15), and visiting another treatment facility (aOR 6.52, 95% CI 4.21-10.12). Interpretation and conclusions Over half of stroke patients arrive late due to various factors. Increasing awareness about stroke and the 'golden hour' is vital to reduce prehospital delays.
Background and objectives Teleconsultation through eSanjeevani can reduce the burden on secondary and tertiary hospitals and meet healthcare delivery challenges in rural and remote areas. This study explored doctors' perspectives to assess the acceptability of teleconsultation and to identify perceived benefits and challenges of teleconsultation services in Manipur. Methods A qualitative study was conducted from January to May 2024 among doctors registered with eSanjeevani in Manipur. In-depth interviews were conducted with purposively selected doctors from different districts, and data were analysed thematically using an abductive approach. Thematic saturation was achieved after 11 interviews. Results Involved doctors perceived teleconsultation as acceptable to patients, doctors, and the health system. Participants reported improved access to general and specialist care in remote areas, with reduced travel, costs, and time for patients. Key benefits included early case identification, timely referral, follow up of chronic diseases, and maintenance of electronic medical records. Community health officers (CHOs) played an important role in enhancing consultation quality and acceptability. Major challenges included poor network connectivity, limited direct physical examination, limited public awareness, unclear guidelines, increased workload due to the absence of designated telemedicine doctors, the absence of regular review mechanisms, and limited availability of medicines and diagnostic facilities at peripheral facilities. Interpretation and conclusions Teleconsultation was acceptable and beneficial in improving access to healthcare, despite persistent operational challenges. Designating dedicated telemedicine doctors with structured rosters, regular specialist scheduling, capacity-building for CHOs, improved dissemination of guidelines, IEC-based awareness generation, and stakeholder motivation are essential for sustaining teleconsultation services.
Background and objectives Elder neglect, characterised by unmet care needs, social isolation, and emotional distress, has been consistently reported in epidemiological studies, yet it continues to be insufficiently acknowledged as a major public health concern in India. Existing frameworks inadequately explain how factors interact to produce neglect and abandonment. This study aimed to explore the circumstances leading to neglect among elderly cancer patients in Puducherry and Tamil Nadu. Methods A qualitative grounded theory design was used. Data were collected through five in-depth interviews, six key informant interviews, and 156 narrative accounts from 52 patient-caregiver-community triads using the SENILE-C tool. Transcribed interviews were analysed through open, axial, and selective coding using constant comparative methods, supported by theoretical sampling, member checking, and multi-coder triangulation. Theory triangulation with the theory of planned behaviour, Maslow's hierarchy, broken windows theory, and the interplay theory helped contextualise how neglect develops and escalates. Results Neglect emerges as a dynamic, progressive process that begins with subtle lapses in care and can escalate to overt abandonment. Vulnerability was shaped by individual factors (self-neglect, emotional distress, functional decline), family-level pressures (caregiver burnout, economic strain, substance use, exploitation), and community influences (stigma, discrimination, weak social support, limited palliative care). The interplay theory showed how combined pressures across these domains can push families beyond their coping threshold, leading to worsening neglect. Interpretation and conclusions The study highlights neglect as a cumulative, socially reinforced process requiring multi-level interventions. Strengthening caregiver support, addressing financial and social barriers, and expanding community-based palliative care services may help prevent escalation of neglect and improve outcomes for elderly cancer patients.
Background and objectives Sarcopenia is a recognised determinant of adverse health outcomes yet remains insufficiently quantified in India. We conducted a systematic review and meta-analysis to estimate the prevalence of sarcopenia and document the diagnostic criteria used across community and hospital-based populations in India. Methods We searched PubMed, EMBASE, Web of Science, and Scopus databases from their inception to December 2, 2025 (PROSPERO registration: CRD420251252940). Cross-sectional and cohort studies reporting prevalence were included. The primary outcome was the prevalence of different types of sarcopenias (probable, confirmed, or severe). Risk of bias was assessed using the Joanna Briggs Institute tool. Pooled prevalence with 95% confidence intervals (CI) was calculated using a random-effects model in R software. Results Of the 5,486 records retrieved, we included 44 studies for final review. Consensus-based definitions, such as Asian and European working group criteria, were used in 54.5% (n= 24) studies, while the remaining used heterogeneous, nonuniform operational criteria. The pooled prevalence of probable, confirmed, and severe sarcopenia was 36.3% (95% CI: 26-48%, 18 studies), 35.4% (95% CI: 28.8-42.5%, 38 studies), and 9.9% (95% CI: 5.6-16.7%, 11 studies), respectively. Interpretation and conclusions Over one in three individuals in India had sarcopenia. We documented an inconsistency in diagnostic criteria across studies, limiting comparability and hindering accurate burden estimation. Our review recommends the need for standardised, setting-specific definitions to enable timely identification, and strengthen evidence-informed public health planning in India.
Background and objectives Leprosy is a neglected tropical disease caused by Mycobacterium leprae often resulting in nerve damage, numbness, disfiguring lesions, and disability. India accounts for ∼52% of the world's new leprosy patients. Immunotherapy has been reported to achieve faster bacterial clearance in multi-bacillary (MB) leprosy patients. We conducted this systematic review to synthesise the global evidence available for the efficacy and safety of the MIP vaccine (Mycobacterium indicus pranii), previously known as Mw, as an immunotherapeutic agent along with standard chemotherapy, on the treatment outcomes in patients with multi-bacillary (MB) and pauci-bacillary (PB) leprosy. Methods Three bibliographic databases namely, PubMed, Embase, and Cochrane Library were used for search of articles apart from four clinical trial registries, Google Scholar, and the Google search engine. Articles published between 1980 to 2023 reporting the efficacy of the MIP vaccine for immunotherapy along with standard chemotherapy in leprosy patients were included. Methodological bias was assessed using the RoB2 and ROBIN-I tool. Meta-analysis was carried out from four RCTs and three non-RCTs for the outcomes clinical score and bacterial index following 12 and 24 mo of treatment using the Review Manager 5.4.1 (RevMan). Results The pooled analysis of four RCTs with 12 and 24 mo of follow up showed a significant reduction in clinical scores with mean difference of -1.35 [95% confidence interval (CI): -2.12 to -0.57] and -2.62 (95% CI: -4.28 to -0.96) respectively, while the analysis of three non-RCTs showed a mean difference of -2.97 (95% CI: -4.00 to -1.94) and -3.10 (95% CI: -3.84 to -2.37) at 12 and 24 mo respectively. Subgroup analysis showed a significant reduction in clinical scores and bacterial index among borderline lepromatous (BL) and lepromatous leprosy (LL) types of leprosy. The vaccine was reported to be safe and well-tolerated. Interpretation and conclusions This systematic review and meta-analysis confirms the clinical efficacy of the MIP as an immunotherapeutic vaccine in leprosy patients for rapid bacterial clearance and overall clinical improvement when used as an adjunct to chemotherapy.
Background and objectives Lipidomics has advanced cancer research by uncovering biomarkers that reveal key mechanisms of tumourigenesis. By analysing endpoint lipid metabolites influenced by genetic and environmental factors, the lipidome closely reflects a cell’s functional state. Mass spectrometry, strengthened by modern bioinformatics and biostatistics, now enables precise detection of cancer-related lipid changes, motivating us to adopt this approach. Methods We have applied advanced mass spectrometry and machine-learning methods to develop a novel tool for cervical cancer screening, the second most common cancer in India. The study included cervical cancer patients diagnosed through cytology, HPV testing, histopathology, or imaging, along with healthy volunteers as controls. Serum samples from all participants were analysed using Ultra High Performance Liquid Chromatography coupled with high-resolution Orbitrap Mass Spectrometry using a targeted approach for lipid biomarker discovery. Results A comprehensive evaluation of controls and cervical cancer patients across clinical stages revealed distinct lipidomic patterns and biomarker differences. We identified a 3-biomarker panel [LPE (22:6)+H, PE (18:1_20:4)+H, and MG (20:0)+H] effective for early-stage detection and a 4-biomarker panel (LPE (22:6)+H, PE (18:1_20:4)+H, PC (16:1_20:5)+H, and TG (16:0_18:1_18:3)+H) suitable for comprehensive cervical cancer screening. The combined ROC for the 3-biomarker panel showed 88% sensitivity, 93% specificity, 90% accuracy, and an area under the curve (AUC) of 0.945, while the 4-biomarker panel achieved 87% sensitivity, 84% specificity, 86% accuracy, and an AUC of 0.946. Interpretation and conclusions Our study demonstrates a clear link between altered lipid metabolism and cervical cancer, paving the way for future research to identify new diagnostic and prognostic markers and ultimately enabling earlier detection and timely intervention.
Background and objectives Acinetobacter baumannii is a major intensive care unit (ICU)-associated pathogen due to associated extensive drug resistance. Regional data from southern Saudi Arabia remain limited. This study aimed to describe overall and temporal resistance patterns of ICU-associated A. baumannii. Methods We conducted a 12-y retrospective study (August 2012- August 2024) at Aseer Central Hospital, Saudi Arabia, analysing Acinetobacter spp. clinical isolates from ICU and non-ICU settings. Species identification and antimicrobial susceptibility testing (AST) were performed using the VITEK® 2 system, with susceptibility interpreted per CLSI M100 guidelines. Carbapenem-resistant A. baumannii (CRAB) and difficult-to-treat resistance phenotypes were defined. Temporal trends were assessed via logistic regression. Results Of 3,935 isolates, 96.6% were A. baumannii. ICU-derived isolates (48.5%) showed significantly higher resistance rates across nearly all antibiotic classes compared to non-ICU isolates (P<0.001). Carbapenem resistance rates remained above 90% throughout the study period, while difficult to treat resistance ranged between 65.2 to 96.1%. Logistic regression revealed significant temporal declines in resistance to cefepime, ceftazidime, aminoglycosides, and fluoroquinolones (P<0.001). Interpretation and conclusions Acinetobacter baumannii isolates from ICU settings in southern Saudi Arabia exhibit persistently high resistance, including carbapenem resistance and difficult-to-treat resistance. We observed significant temporal declines in resistance to selected agents, particularly cefepime, aminoglycosides, and fluoroquinolones. These findings highlight the critical role of ICU-focused antimicrobial stewardship, enhanced infection control strategies, and regional molecular surveillance to limit further spread.
Human papillomavirus (HPV) genotype distribution varies regionally, influencing vaccination and screening strategies. This molecular characterisation study determined HPV prevalence and circulating genotypes among 225 women (≥30 y) attending gynaecological clinics in Karad, Satara district, Maharashtra. HPV DNA was detected in 14 participants (6.2%) using polymerase chain reaction (PCR) and sequencing. Identified genotypes included HPV-6, HPV-59, HPV-66, and HPV-81, indicating circulation of both low-risk and high-risk types. Multiple sexual partners showed the strongest association with HPV infection. These preliminary findings highlight the need for region-specific genotype surveillance to inform prevention strategies.
Background and objectives In India, limited awareness regarding the potential adverse effects of medical termination of pregnancy (MTP) pills, coupled with their non-prescribed over-the-counter availability, has led to their widespread unsupervised use. Such practices may result in serious maternal complications. This study aimed to describe the clinical profile and outcomes among women presenting to a tertiary care hospital following unsupervised self-administration of MTP pills. Methods A record-based retrospective study was carried out at a tertiary academic medical centre. Case files of women who attended between January and June 2025 with a documented history of self-administered MTP pills were retrieved and evaluated for clinical outcomes and complications. Results Seventy-six women fulfilling the inclusion criteria were enrolled. Women aged 25-30 y constituted the largest group (30/76; 39.5%). The predominant diagnosis was incomplete abortion (54/76; 71.1%), with shock complicating 10/76 (13.2%) and sepsis complicating 8/76 (10.5%) cases. Dilatation and evacuation was performed in 42/76 (55.3%) patients. Serious adverse outcomes comprised 2 maternal deaths, 5 intensive care unit admissions, and 18 women with prolonged hospitalisation beyond three days. Interpretation and conclusions Among women presenting to a tertiary care hospital after unsupervised use of MTP pills, incomplete abortion was the most frequent complication, often accompanied by shock and sepsis. These findings underscore the need for strengthening public awareness, enforcing existing regulations, and promoting supervised medical abortion services to reduce preventable maternal morbidity.
Background and objectives Comprehensive immune-cell subset characterisation in healthy adults is the prerequisite for enabling accurate diagnosis of primary immunodeficiencies and informed therapeutic decision-making in targeted immunotherapies. Herein, we aim to establish biological reference intervals (BRIs) for leukocyte subsets for interpreting immunophenotypic data and identifying deviations in different pathological settings. Methods This prospective study was conducted at a tertiary care hospital and research centre in northern India over a period of six months using standardised multiparametric flow-cytometric immunophenotyping (FCMI). Peripheral blood from 120 healthy adult donors was analysed by 13-color, 15-parameter flow cytometry (Beckman Coulter Dx Flex). Thirty-seven leucocyte subsets were identified based on expression of surface markers including lymphoid (B, T and their subsets), myeloid (granulocytes, dendritic cells, monocytes and its subsets) and NK cell subsets. Frequencies and absolute counts were compared across gender and age groups by Mann-Whitney U and Kruskal-Wallis tests (P≤0.05). Results Males showed higher median total lymphocytes, absolute T-cells, cytotoxic T and memory T-regs, while females exhibited higher % of T-lymphocytes, helper T cells, and early terminally differentiated effector memory re-activating cells (TEMRA ) fractions. B-cell analysis revealed higher mature, transitional, switched-memory, and circulating plasma-cell counts in males. Naïve B cells remained the predominant subset across adulthood, showing biphasic variation with age, while memory B cells peaked in early adulthood, followed by a decline. Interpretation and conclusions When compared with Euro-Flow data, Indian adults displayed overall concordance with global reference ranges, though with broader variability in T and B subsets. These baseline values will refine immune monitoring, improve diagnostic precision in immunodeficiency disorders and guide therapeutic decisions in immune-modifying therapies.
Background and objectives Accredited social health activists (ASHAs) play a key role in community mental health services in Karnataka; however, evidence on training interventions has not been systematically reviewed. We aimed to systematically synthesise evidence on mental health training interventions for ASHAs in Karnataka, focusing on provider competencies and service delivery outcomes. Methods Systematic search of databases, trial registries, and grey literature (October 2025-January 2026) included studies published between 2000 and 2025. Eligible studies involved ASHAs in Karnataka and evaluated mental health training interventions with outcomes related to provider competencies or service delivery. Due to heterogeneity, findings were synthesised narratively using SWiM guidelines for quantitative studies and GRADE-CERQual for qualitative. The risk of bias was assessed using RoB 2, ROBINS-I (v2), MMAT, and CASP. Results Of 648 records screened, 13 studies comprising 567 ASHAs met the inclusion criteria. Narrative synthesis showed improved provider competencies and service delivery outcomes from quantitative studies, while qualitative studies revealed moderate confidence. Overall, risk of bias was judged as 'low to some concerns'. Digital and hybrid models showed more sustained gains than standalone in-person training. Selected service delivery outcomes, including screening coverage, home visits and supervisory engagement, improved with structured support. However, the evidence was limited by pre-post designs, small sample size, reliance on self-reported outcomes, and heterogeneity in interventions and outcome measures. Interpretation and conclusion Structured training may improve ASHAs' mental health provider competencies and service delivery. Digital and hybrid models are promising, but evidence remains limited, highlighting the need for rigorous studies with standardised outcomes and long-term follow up.
Background and objectives The Indian Council of Medical Research (ICMR) funds small and intermediate grants to help researchers conduct their own biomedical research. The study examined the ICMR-funded small and intermediate grant projects between 2023 to 2025 to evaluate institutional involvement, thematic concentration, and geographic dispersion. Methods The data were extracted manually from six publicly available ICMR funding lists for small and intermediate grants (2023-2025). Institutes were categorised as: medical and non-medical/technical. We used keywords to code project titles so we could find the main research themes. We also looked at the geographic distribution based on where the grantee institute was located. Results Out of 1,766 project grants, 1,220 (69.1%) of the projects that got funding were from government institutions, while 546 (30.9%) were from private, trust, or NGO institutions. Medical institutions received 1,084 (61.4%) of grants, while non-medical/technical institutions received 682 (38.6%) grants with technical institutions increasingly participating throughout the study period. Subjects receiving maximum funding were oncology, infectious diseases (especially tuberculosis), and non-communicable diseases. About 70% of the funded projects were from institutions in north and south India, combined. Interpretation and conclusions The analysis shows that medical and technical institutions are getting almost similar funding from ICMR between 2023 and 2025. Geographic and institutional concentration remains high in north/south India. These results shed light on recent trends in funding distribution and point out areas where research capacity could be improved.
Background and objectives The utilisation of hysterectomy has emerged as a public health concern in India. The Ministry of Health’s National Guidelines aim to reduce unnecessary hysterectomies by promoting adherence to recommended indications, age, and extent of surgery. Although audits are routinely conducted in tertiary hospitals, their findings have not been synthesised. We present a synthesis of medical audits of hysterectomy practices in India to identify patterns, gaps, and opportunities to improve the quality of care. Methods This systematic review included medical audits of hysterectomies in India published between 2010 and 2024 across PubMed, Scopus, and EMBASE. Using PRISMA guidelines, a systematic search and narrative synthesis were conducted to examine clinical indications, surgical route, complications, and histopathological correlations. Study selection and quality assessment were carried out independently by two reviewers using the Joanna Briggs Institute critical appraisal tool. Results The review included 89 medical audits, mostly of moderate quality. Hysterectomies were predominantly performed in premenopausal women, with one-fourth in women under 40 years. The leading indications were abnormal uterine bleeding and fibroids, commonly managed by abdominal surgery. Oophorectomy was frequently performed without documented ovarian pathology. Reported complications included haemorrhage, postoperative fever, and urinary tract infections. Interpretation and conclusions This review identified benign gynaecological conditions, particularly fibroids, as the predominant indication for hysterectomy. It also revealed substantial gaps in standardised reporting, clinicopathological documentation, and sociodemographic data. Strengthening audit systems, ensuring adherence to evidence-based guidelines, and expanding access to conservative and minimally invasive treatments are essential to support rational surgical decision-making and improve the quality of gynaecological care.
Background and objectives Endometrial carcinoma is the most common gynaecological malignancy and an emerging global health concern with limited molecular data from Indian cohorts. Our study investigated the molecular subtypes and POLE gene mutation spectrum in the South Indian cohort. Methods Molecular subtyping was carried out using ProMisE classification, categorising patients into four molecular subgroups. This involved immunohistochemistry for mismatch repair proteins, p53abn, and Sanger sequencing for POLE mutations. POLE variants were further classified, and the pathogenicity was evaluated using in silico tools. Results Histopathology presented endometrioid carcinoma in 84.9% (n= 45) cases in our study. Molecular classification revealed POLE ultra-mutated (3.8%, n=2), MMR-deficient (18.9%, n=10), p53-abnormal (17.0%, n=9), and NSMP (37.7%, n=20) subgroups. POLE gene sequencing identified 11 exonuclease domain variants, including the recurrent endometrial carcinoma hotspot V411L (3.8% ,n=2) and ten non-hotspot variants such as T323I, T457M, T466I, V460M, L306P, P441S, A465V, T290I, E321K, and T278A (22.6%, n=12). Among these, six variants T466I, V460M, L306P, P441S, T290I, and E321K were unique in our cohort, and V460M, P441S, T290I, and E321K were predicted to have oncogenic potential. Clinically, p53abn tumours showed an aggressive phenotype with higher rates of advanced-stage disease and chemotherapy use (55.6%, n=5) compared with POLE -mutated (n=0), Mismatch repair-deficient (MMRd) (37.5%, n=3), and no specific molecular profile (NSMP) tumours (10.0%, n=2). Interpretation and conclusions This study demonstrates that integrating molecular profiling with histopathology to develop clinically applicable assays strengthens endometrial carcinoma classification and improves routine prognostic assessment.
