Muthanna Medical Journal

Background: Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in metastatic non–small cell lung cancer (NSCLC), yet durable clinical benefit (DCB) is achieved in only a subset of patients. Established biomarkers such as PD-L1 expression and tumor mutational burden (TMB) incompletely predict response, while emerging evidence suggests that gut microbiome composition may further modulate immunotherapy efficacy. We conducted a prospective multi-center study in China to evaluate the independent and integrated predictive value of PD-L1, TMB, and microbiome signatures for durable immunotherapy response. Methods: In this prospective cohort study, 286 patients with metastatic NSCLC receiving PD-1/PD-L1 inhibitors were enrolled across three tertiary cancer centers in China. Pretreatment tumor samples underwent PD-L1 immunohistochemistry and targeted next-generation sequencing for TMB assessment. Baseline stool samples were analyzed using 16S rRNA sequencing to evaluate microbial diversity and taxonomic composition. Durable clinical benefit was defined as response or stable disease lasting ≥ 12 months. Multi-omic integration was performed using canonical correlation analysis and machine-learning–based predictive modeling. Results: Durable clinical benefit was observed in 32.2% of patients. PD-L1 TPS ≥ 50% was associated with improved progression-free survival (median 14.8 months; HR 0.56; P = .001). High TMB (≥ 10 mut/Mb) correlated with increased DCB rates (47.4% vs 26.2%; P = .002). Responders demonstrated significantly higher microbial diversity (Shannon index 4.08 vs 3.22; P < .001) and enrichment of Akkermansia muciniphila, Faecalibacterium prausnitzii, and Bifidobacterium longum. Integrated multi-omic modeling outperformed individual biomarkers in predicting DCB, identifying biologically distinct subgroups with markedly different survival outcomes. Conclusion: In this Chinese multi-center cohort, PD-L1 expression, tumor mutational burden, and gut microbiome composition represent complementary predictors of durable immunotherapy response in metastatic NSCLC. Multi-omic integration significantly enhances predictive precision and may inform personalized treatment strategies. These findings support incorporation of multidimensional biomarker profiling into precision oncology practice in China.

Background: Streptoccocus Oralis is an early colonizer in dental biofilm and contributes to plaque formation and periodontal inflammation. The search for safe, natural antimicrobial alternatives has increased interest in herbal agents such as Triphala and Aloe vera. However, their combined activity against S. oralis has not been fully assessed alongside phytochemical profiling.

Aim: To evaluate the antibacterial activity of aqueous-extracted Triphala, Aloe vera, and their combination against S. oralis, including inhibition zone measurement, MIC, MBC, and HPLC characterization. Materials and Methods: Aloe vera gel and Triphala powder were extracted using aqueous extraction and freeze-drying. Antibacterial activity was assessed using agar well-diffusion, MIC, and MBC assays at concentrations of 20–100%. Chlorhexidine 0.12% served as the positive control. Statistical analysis included one-way ANOVA and LSD tests. Phytochemical profiling of Triphala was performed using HPLC.

Results: The combination extract demonstrated the strongest antibacterial effect, producing inhibition zones of 18.75–25.25 mm, significantly higher than Aloe vera, Triphala alone, and chlorhexidine 0.12% (mean CHX = 13–14 mm; p < 0.05).

The MIC of the combination extract was 5–10%, while the MBC was 20%, indicating potent inhibitory and bactericidal activity at low concentrations.

HPLC profiling of Triphala revealed abundant polyphenols including chebulagic acid (RT 3.51 min), chebulinic acid (RT 3.90 min), gallic acid (RT 4.33 min), ellagic acid (RT 4.92 min), rutin (RT 4.66 min), quercetin (RT 10.05 min), apigenin (RT 16.72 min), chlorogenic acid (RT 18.19 min), and catechin (RT 21.26 min). Vitamin analysis also identified a dominant Vitamin C peak at RT 4.89 min, supporting strong antioxidant potential.

HPLC of Aloe vera identified major anthraquinones including Aloin A/B (RT 5.03 min; 65% of total area), Aloe-emodin (RT 6.27 min), and Emodin (RT 10.14 min) compounds widely recognized for antibacterial, anti-biofilm, and membrane-disruptive effects.

The combined presence of Triphala polyphenols and Aloe vera anthraquinones explains the observed synergistic antibacterial effect against S. oralis.

Conclusion: The aqueous combination of Triphala and Aloe vera exhibits a synergistic, potent antibacterial effect against S. oralis, with inhibition zones surpassing chlorhexidine and demonstrating low MIC (5–10%) and bactericidal MBC (20%). Supported by rich polyphenolic and anthraquinone content identified by HPLC, this combination represents a promising natural alternative or adjunct to chemical antimicrobials for early plaque control.

Background: Human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer represents an aggressive subtype of breast cancer historically associated with poor prognosis. The introduction of HER2-targeted therapies has significantly improved clinical outcomes; however, survival varies considerably among patients. Identifying prognostic factors that influence treatment response and survival is essential for optimizing patient management. This study aimed to evaluate clinical prognostic factors affecting survival outcomes in patients with HER2-positive metastatic breast cancer treated with targeted therapy in Spain. Methods: A retrospective multicenter cohort study was conducted across several oncology centers in Spain. The study included women aged ≥ 18 years with histologically confirmed HER2-positive metastatic breast cancer who received at least one line of HER2-targeted therapy between January 2014 and December 2022. Clinical data were extracted from institutional electronic medical records and oncology databases. Variables analyzed included demographic characteristics, hormone receptor status, metastatic site distribution, treatment patterns, and survival outcomes. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards regression analyses. Results: A total of 168 patients were included in the study, with a median age of 55 years at diagnosis of metastatic disease. Hormone receptor–positive tumors were identified in 61.9% of patients. Visceral metastases were present in 66.7% of cases, and 17.3% of patients developed brain metastases. The median follow-up duration was 42 months. The median overall survival for the entire cohort was 48.6 months, while the median progression-free survival following first-line HER2-targeted therapy was 14.8 months. Multivariate analysis identified visceral metastases (HR 1.68; 95% CI 1.11–2.54) and brain metastases (HR 2.14; 95% CI 1.33–3.45) as independent predictors of poorer survival. Conversely, hormone receptor positivity (HR 0.72; 95% CI 0.51–0.96) and the use of dual HER2 blockade in the first-line setting (HR 0.64; 95% CI 0.44–0.91) were associated with improved survival outcomes. Conclusion: In this multicenter real-world study from Spain, several clinical factors significantly influenced survival in patients with HER2-positive metastatic breast cancer treated with targeted therapy. Hormone receptor positivity and the use of dual HER2 blockade were associated with improved outcomes, whereas visceral and brain metastases predicted poorer prognosis. These findings emphasize the importance of tumor biology and treatment strategy in determining survival and support the continued use of early intensive HER2-targeted therapy in metastatic disease.

Background: Urinary tract infections (UTIs) are the second most common infection in women and frequently recur in young hostel-dwelling females. This study aims to estimate the Proportion of UTI and identify associated behavioural and hygiene-related risk factors among female medical students aged 17–25 years. Methods: An institution-based cross-sectional analytical study was conducted from August to October 2024 at Dr. Somervell Memorial C.S.I. Medical College, Karakonam. Sample size of 139 was calculated using Proportion of 40.8% with 8% precision. All eligible female students were included after written informed consent. A pre-tested, semi-structured questionnaire was used. Data were analysed using SPSS version 26; χ2 test and Fisher’s exact test were applied (p < 0.05 significant). Results: Lifetime Proportion of UTI was 41.7% (58/139) and one-year Proportion was 28.1% (39/139). Burning micturition (68.9%), lower abdominal pain (55.2%), and urgency (46.6%) were the most common symptoms. Significant risk factors were: changing undergarments less than once daily (p = 0.024), holding urine for prolonged periods (p = 0.047), occurrence predominantly in summer (p < 0.001), and adoption of preventive lifestyle changes after previous UTI (p = 0.022). Conclusion: More than two-fifths of female medical students experienced UTI. Modifiable risk factors related to voiding behaviour and genital hygiene were identified. Targeted interventions in medical colleges are recommended.

Background: Cytokines mediate resistance to tuberculosis infection and play a significant role in host susceptibility and the progression of the infection. Aim: This study aimed to determine whether plasma levels of IL-17, IL-10, and VEGF can discriminate between non-resistant TB, monoresistant TB, Multidrug-resistant TB, and TB-negative subjects. Methods: Three hundred and twenty-five presumptive TB patients were recruited from 2020 to 2023 in the North-western region of Nigeria as study participants from whom sputum and blood samples were collected. The sputum samples were processed accordingly to detect drug-susceptible, monoresistant, and multidrug-resistant Mycobacterium tuberculosis (MDR-TB) using the Ziehl-Neelsen staining technique, GeneXpert, and Lowenstein-Jensen medium, based on which the participants were categorised into three groups: the drug-susceptible group, monoresistant group, and MDR-TB group. In contrast, the blood samples were used to determine the IL-10, IL-17 and VEGF plasma levels of all the groups using the Melsin ELISA test kit. Results: In all three groups, the plasma level of VEGF was the most elevated; however, there was a significant statistical association between IL-17, and VEGF when the groups were compared (p = 0.000). The Receiver operating characteristic curve (ROC) assessment for IL-10, IL-17, and VEGF showed that the area under the curve (AUC) for IL-17 was the highest for all the three groups (0.743, 0.858, and 0.99). Conclusion: This study indicates IL-17 as the best overall diagnostic performance as a discriminator between non-resistant TB, Mono-resistant TB and the MDR-TB group.