Background/Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder associated with systemic inflammation, metabolic dysfunction, and altered intestinal permeability. Emerging evidence suggests interactions between oral health and systemic inflammatory pathways; however, phenotype-specific associations between oral hygiene status and systemic biomarkers in PCOS remain unclear. This study aimed to evaluate the relationship between oral hygiene indices and inflammatory, metabolic, and intestinal permeability biomarkers in women with classical and non-classical PCOS. Methods: This cross-sectional study included 83 women, consisting of 39 patients with classical PCOS and 44 patients with non-classical PCOS. Oral hygiene status was assessed using the Oral Hygiene Index–Simplified (OHI-S), including debris and calculus scores. Serum interleukin-1 beta (IL-1β), anti-Müllerian hormone (AMH), zonulin, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were measured using enzyme-linked immunosorbent assay. Statistical analyses were performed to compare group characteristics and evaluate phenotype-specific correlations between oral hygiene indices and systemic biomarkers. Results: No significant differences were observed in debris score, calculus score, total OHI-S score, IL-1β, AMH, zonulin, or HOMA-IR among classical PCOS, non-classical PCOS, and control groups. In classical PCOS, the calculus score was negatively correlated with zonulin levels (ρ = −0.37; p = 0.022). In non-classical PCOS, debris score and total OHI-S score were positively correlated with zonulin levels (ρ = 0.46, p = 0.002 and ρ = 0.37, p = 0.013, respectively). No significant correlations were identified between oral hygiene indices and IL-1β, AMH, or HOMA-IR. Conclusions: Oral hygiene status and systemic biomarker levels did not differ significantly between women with PCOS and healthy controls. However, phenotype-specific associations between oral hygiene indices and zonulin suggest a potential role of the oral–intestinal axis in PCOS pathophysiology, particularly in non-classical PCOS.

Background/Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder. Rotterdam-defined phenotypes may need adjunctive, non-invasive signals for research-level phenotypic stratification. Saliva deserves attention because it is easy to collect repeatedly, acceptable in outpatient settings, and may reflect oral-systemic inflammatory and endocrine-metabolic interactions. This study evaluated whether salivary qPCR signals for Lactobacillus, Prevotella, and Bifidobacterium differ across Rotterdam-defined PCOS phenotypes and controls, with emphasis on the exploratory relevance of Prevotella. Methods: This cross-sectional proof-of-concept study included 110 women: 87 with PCOS and 23 controls. PCOS phenotypes were classified according to the Rotterdam criteria. Salivary microbial targets were assessed using SYBR Green-based genus-specific qPCR. Available instrument-export spreadsheets were reviewed for standard-curve quality control. Because the available assay outputs did not support robust absolute quantification, inferential analyses used Cq-based microbial signals only. Lower Cq values indicate stronger target DNA signal. No universal bacterial 16S rRNA reference, exogenous spike-in, salivary flow correction, or fully validated copy-number conversion was available. Group differences were evaluated using non-parametric tests with Bonferroni-corrected post-hoc comparisons. ROC, regression, and correlation analyses were retained as hypothesis-generating analyses only. Results: Prevotella Cq values differed significantly across groups (p < 0.001), with lower median Cq values in phenotypes A, B, and C than in phenotype D and controls. Lactobacillus Cq values did not differ significantly (p = 0.249). Bifidobacterium showed an overall group difference (p < 0.001), but its pattern and assay performance were less consistent. Among women with PCOS, Prevotella Cq values were associated with Ferriman-Gallwey score and polycystic ovarian morphology. Conclusions: Salivary Prevotella showed the clearest exploratory genus-level qPCR signal across Rotterdam-defined PCOS phenotypes. The findings support further technical and clinical validation of saliva-based microbial profiling as a possible adjunct to conventional PCOS phenotyping. They do not validate Prevotella as a standalone diagnostic biomarker, do not define clinical cutoffs, and do not quantify absolute bacterial load.

Endometriosis, a chronic inflammatory condition linked to pelvic pain and infertility, is characterized by immune dysfunction involving dysregulated apoptosis and cell proliferation. This case-control study included 87 infertile women undergoing diagnostic laparoscopy and assessed serum and peritoneal levels of sEGFR, sFas, and sFasL using ELISA. Pain intensity was evaluated via the Visual Analog Scale (VAS). Peritoneal sFasL concentrations were significantly higher in infertile women with pelvic pain (p = 0.012) and correlated with VAS scores (r = 0.261, p = 0.014). Serum and peritoneal sFasL levels were significantly elevated in endometriosis patients with pelvic pain compared to controls (p = 0.003, p = 0.002, respectively). Peritoneal sFasL levels were also associated with dysmenorrhea and dyspareunia. ROC analysis demonstrated that serum sFasL differentiated endometriosis from controls (AUC = 0.797, p < 0.001). These findings suggest that sFasL may serve as a potential noninvasive biomarker for endometriosis. Further research should investigate its regulatory role in endometriosis-related pain.

Polycystic ovary syndrome (PCOS) is the most common endocrinology disorder affecting women of reproductive age, characterized by irregular menstruation, androgen overproduction and insulin resistance. Peroxisome proliferator-activated receptor-gamma (PPARG) is one of the essential modulators of ovarian steroid hormone synthesis and lipid metabolism. Precision medicine and targeted therapy have emerged as practical therapeutic approaches, focusing on specific molecules/pathways to minimize side effects and improve outcomes. This study aimed to identify potential Indonesian phytoconstituents that inhibit PPARG both from a pharmacokinetic and pharmacodynamic perspective based on the in silico approach. Data of 6776 phytoconstituents from the Indonesian Medicinal Plant Database were screened for compounds with Pa>0.3 as “Insulin Sensitivity”, “Lipid metabolism”, and “Anti-inflammation” using PASSOnline. We performed pharmacokinetic profile prediction using SwissADME based on Lipinski criteria. Molecular docking was carried out with PPARG as the target proteins, utilizing PyMol, Pyrx, and Discovery Studio to evaluate top-hit compounds with the highest binding affinity. Through in silico screening and molecular docking, Quercitol exhibited superior binding with the protein target compared to the control ligands and metformin. Quercitol also met the Lipinski criteria, showing favourable bioavailability as a drug candidate. Hence, these findings will provide a theoretical basis for further studies as regards drugs targeting PPARG in PCOS.

Pelvic pain, often associated with endometriosis, significantly affects women's quality of life. This study explored the soluble neural cell adhesion molecules (sNCAM), soluble interleukin 2 receptor α (sIL-2Rα), and IL-2 levels in the serum and peritoneal fluid of infertile women with pelvic pain. We enrolled 86 infertile women aged 24 to 41 years undergoing diagnostic laparoscopy: 44 women with endometriosis and 42 women who acted as controls. Pain intensity was assessed using the visual analog scale. The soluble molecules were measured using enzyme-linked immunosorbent assay. Serum and peritoneal sNCAM, sIL-2Rα, and IL-2 levels were statistically significantly higher in women with pelvic pain. Both serum and peritoneal sNCAM levels correlated with visual analog scale scores, indicating a relationship between these markers and pain severity. Elevated peritoneal sIL-2Rα levels were also associated with pelvic pain. Receiver operating characteristic curve analysis showed the potential of serum sNCAM in distinguishing between mild and moderate to severe pain. Elevated levels of sNCAM, sIL-2Rα, and IL-2 in serum and peritoneal fluid correlate with pelvic pain severity in infertile women, suggesting their involvement in disease pathogenesis and potential as objective biomarkers for pain assessment in endometriosis. Further research is needed to validate these findings for clinical use.

BACKGROUND:Endometriosis is a chronic inflammatory condition often associated with infertility. The role of granzymes as cytotoxic proteases and immune regulators in endometriosis remains poorly understood. This study evaluated serum and peritoneal fluid levels of granzymes A, B, and K in women with endometriosis and their links to disease severity. METHODOLOGY:An observational study of 87 infertile women undergoing diagnostic laparoscopy, including 44 with endometriosis and 43 benign gynecologic controls. Granzyme levels were measured using ELISA and correlated with clinical parameters. RESULTS:Serum GrB and GrK were significantly higher in women with endometriosis, particularly in advanced stages. Peritoneal fluid revealed reduced GrA and increased GrB in the endometriosis group. Serum GrB and GrK levels correlated positively with rASRM adhesion and endometriosis severity scores, while GrB levels correlated inversely with the Endometriosis Infertility Index (EFI) score, indicating their role in predicting infertility. Combining serum GrB and GrK effectively differentiated endometriosis from control, highlighting their diagnostic potential. CONCLUSION:Elevated serum GrB and GrK levels suggest their involvement in endometriosis pathogenesis and infertility. These findings highlight granzymes as promising biomarkers for disease severity, diagnosis, and targeted therapy in endometriosis management.

Objectives: Myeloid cell-derived factors contribute to the immunopathology of endometriosis. Soluble CD14 (sCD14), CD163 (sCD163), and MIF serve as in vivo markers of myeloid function. However, these soluble molecules are largely unexplored in women with endometriosis-related infertility cases. We investigated three soluble markers, namely sCD14, sCD163, and MIF, in cases of infertility associated with endometriosis and correlated its level to the stage of endometriosis. Design: Eighty-seven women newly diagnosed with endometriosis or other benign gynecologic control cases linked to infertility were prospectively recruited and underwent diagnostic laparoscopy. Participants: Forty-four patients with endometriosis were included in this study, comprising 19 patients with early-endometriosis (stages I and II) and 25 late-endometriosis (stages III and IV) based on the revised American Society for Reproductive Medicine (rASRM) classification. The remaining 43 patients constituted a control group with infertility due to other causes. Methods: The levels of sCD14, sCD163, and MIF in serum and peritoneal fluid were assessed using ELISA. Results: Endometriosis women exhibited significantly higher serum levels of sCD163 and MIF levels compared to the control group. Both sCD163 and MIF levels displayed a positive correlation with the rASRM adhesion score. Moreover, the MIF level in serum had a positive correlation with the rASRM endometriosis score. In receiver operating characteristic analysis, serum sCD163 and MIF could significantly discriminate endometriosis and non-endometriosis in infertility cases. Limitations: Some limitations of the current study deserve to be underlined. First, the sensitive ELISA method was the sole-validated tool for detecting the markers in patient samples. Second, healthy or fertile women were not involved as the control group. Conclusions: The elevated systemic levels of sCD163 and MIF correlated with the severity of endometriosis. These soluble molecules have a potential diagnostic capacity as a non-invasive biomarker. Furthermore, our data warrants future studies on the underlying mechanism of sCD163 and MIF in endometriosis-related infertility.

OBJECTIVE:To investigate the association between soluble adhesion molecules (sE-cadherin, sE-selectin, sICAM-1, sVCAM-1) in serum and peritoneal fluid and pelvic pain in infertile women with endometriosis. METHODS:This observational study included 86 infertile women undergoing diagnostic laparoscopy, 43 of whom were diagnosed with endometriosis. Pain intensity was evaluated using the visual analog scale (VAS). Levels of soluble adhesion molecules in serum and peritoneal fluid were quantified using ELISA. Statistical analysis included the Mann-Whitney U test for group comparisons, Spearman's rank correlation for associations with VAS scores, and receiver operating characteristic (ROC) curve analysis for diagnostic performance. RESULTS:Serum sE-selectin levels were significantly higher in women with pelvic pain (P = 0.022) and correlated with VAS scores (r = 0.271, P = 0.012). Peritoneal sE-selectin and sICAM-1 levels were elevated in women with pelvic pain (P = 0.044 and P = 0.029, respectively) and showed positive correlations with VAS scores (r = 0.246, P = 0.022 and r = 0.310, P = 0.004, respectively). Comparing endometriosis and control groups, peritoneal sE-selectin and sICAM-1 levels were significantly higher in endometriosis cases with pelvic pain (P = 0.003 and P < 0.001, respectively). ROC analysis revealed the potential diagnostic value of serum sE-selectin (AUC = 0.698, P = 0.002), serum sICAM-1 (AUC = 0.721, P < 0.001), and serum sVCAM-1 (AUC = 0.750, P < 0.001) in distinguishing endometriosis from non-endometriosis cases. CONCLUSION:Elevated levels of sE-selectin and sICAM-1 in serum and peritoneal fluid are associated with pelvic pain in women with endometriosis, suggesting their role in pain pathogenesis and potential as biomarkers for pain severity and disease diagnosis. Further research is warranted to explore the underlying mechanisms and validate these findings in larger cohorts.

INTRODUCTION:Endometriosis is a chronic inflammatory disease characterized by endometrial-like tissue outside the uterus. Molecules linked to natural killer (NK) and cytotoxic T cells, including granulysin (GNLY), MHC class I-related chain A (MICA), and perforin (PRF1) support immune surveillance, though their roles in endometriosis remain unclear. This study investigates the association of these molecules with clinical parameters in infertile women with endometriosis. METHODS:Eighty-seven infertile women undergoing diagnostic laparoscopy were included: 44 with endometriosis and 43 with benign gynecologic disorders. Serum and peritoneal molecules were measured using ELISA. Statistical analyses compared groups and correlated immune markers with clinical parameters. RESULTS:Endometriosis patients displayed significantly higher PRF1 levels in serum (p = .038) and peritoneal fluid (p = .002), particularly in late-stage disease. Serum and peritoneal PRF1 levels correlated positively with the rASRM adhesion scores. Elevated serum PRF1 was observed in ovarian endometrioma (p = .021). Peritoneal MICA was higher in late-stage endometriosis (p = .013). Serum MICA was elevated in the follicular phase compared to the luteal phase (p = .008). CONCLUSION:Elevated PRF1 and MICA levels were associated with endometriosis severity, indicating their potential as biomarkers. Future studies should validate this finding and explore its therapeutic role in endometriosis.

Objective: To describe the prompt and successful treatment of an extrauterine pregnancy case in a tertiary-level hospital in Indonesia. Methods: We report a case of prompt and successful management of unruptured tubal pregnancy in the dr. Soetomo General Hospital Surabaya. Results: Mrs. N (32 years old) presented with lower abdominal pain and vaginal bleeding several days before admission. She was sexually active, used no contraceptives, and had a history of miscarriage. On examination, she was hemodynamically stable. A bimanual exam revealed cervical motion tenderness and pain. A high human chorionic gonadotropin (hCG) level (1,725 IU/L) and a left-sided mass, highly suspected as an extrauterine gestational sac without sign of free fluid in the abdomen nor fetal heart rate on ultrasound, prompted diagnostic laparoscopy. We found a tubal pregnancy located on the ampullae of the left fallopian tube with minimal hemoperitoneum (50 ml). A chromopertubation test was done to ensure a patent right fallopian tube, so we did a salpingectomy. The patient recovered well and was discharged home on day 2 post-procedure. Conclusion: Early diagnosis is vital and feasible to prevent morbidity and mortality in women with ectopic pregnancy. All sexually active women complaining about painful abdomen or bleeding through the vagina must be examined for an ectopic pregnancy to enable early diagnosis and prompt treatment. A laparoscopic surgery done by a trained individual provided a safe and minimally invasive intervention to this case. Keywords: case report, ectopic pregnancy, laparoscopy, salpingectomy, tubal pregnancy

Background: Implant as long-acting reversible contraception (LARC) is ideal for Indonesian women. Two-rod implant (2x75mg levonorgestrel) is the most common implant used in Indonesia. Another alternative method is a one-rod implant (1x150mg levonorgestrel). Objective: This study evaluated the effectiveness, changes in body weight (BW), and menstrual cycle between the one-rod and two-rod implant acceptors. Methods: This study was an RCT design with phase II clinical trials; 179 subjects were recruited. Subjects were met with inclusion and exclusion criteria and divided into one-rod and two-rod groups. The variables were evaluated within 12 months. Results: This study involved 70 subjects in the one-rod implant group and 66 subjects in the two-rod implant group. At 12 months, there were no differences between the effectiveness of the two types of contraception, and pregnancy was reported in 1.26% vs 1.31%. The concentration of levonorgestrel in the one-rod group was 0.31 ng/dL as the median (IQR: 0.33 ng/dL) and 0.34 ng/dL as the median (IQR: 0.33 ng/dL) in the two-rod group (p = 0.438). The BW in the two-rod group increased significantly in month six (p = 0.035) and twelve (p = 0.017) but not in the one-rod group. Menstrual cycle changes occurred in 51.4% of subjects and 57.6% of subjects in the one- and two-rod groups (p = 0.584), respectively. Conclusion: At 12 months, one-rod and two-rod implants had similar effectiveness and concentration of levonorgestrel. Significant weight gain happened in the two-rod group, and the weight gain increased in months six and twelve. Menstrual cycle changes have occurred in both.

Introduction: TNF-α, LT-α, and sCD40L belong to the TNF superfamily and play a pivotal role in chronic inflammatory disease. Yet, these soluble molecules are largely unexplored in endometriosis cases with infertility. The present study aimed to evaluate serum and peritoneal fluid levels of these molecules and correlate its level to the endometriosis severity. Methods: Peripheral blood and peritoneal fluid samples were obtained from 87 infertility cases who underwent laparoscopy, consisting of 44 endometriotic women and 43 non-endometriotic women. The levels of TNF-α, LT-α, and sCD40L were determined using ELISA. Results: Serum and peritoneal TNF-α levels were significantly elevated in the endometriosis group compared to the control group ( p = 0.028; p = 0.027), but not the sCD40L and LT-α level. Serum and peritoneal TNF-α levels were significantly different between late-endometriosis (stage III or IV) compared to the control group ( p = 0.026, p = 0.041, respectively). Moreover, the serum LT-α level was significantly higher in late-endometriosis cases compared to the early-endometriosis (stage I or II) cases ( p = 0.03) and showed a positive correlation with endometriosis rASRM score ( p = 0.001). ROC curve analysis showed a significant diagnostic value of serum LT-α in differentiating the late cases to the early endometriosis patients (AUC = 0.751, p = 0.007). A negative correlation between LT-α and total Endometriosis Fertility Index (EFI) score was also observed ( p = 0.012). Conclusion: Severe endometriosis and lower EFI score are associated with higher serum LT-α level. Serum LT-α is a potential staging biomarker among endometriosis cases. Serum and peritoneal TNF-α levels were elevated in women with severe endometriosis among infertility cases. Further study should address the role and predictive value of LT-α in endometriosis-related infertility.

Background: the most prevalent endocrine disorder in young women is polycystic ovary syndrome (PCOS). In many patients, vitamin D insufficiency aggravates the condition. Early diagnosis of insulin resistance and vitamin D insufficiency will simplify management and reduce morbidity in the future. This study analyzes the relationship between vitamin D levels and HOMA IR and LH in PCOS patients and compares the levels of LH and HOMA IR between obese and non-obese PCOS. Method: This study used a cross-sectional study on 48 women of reproductive age who were diagnosed with PCOS according to the Rotterdam criteria and who met the inclusion and exclusion criteria. Subjects were taken by consecutive sampling, measured levels of vitamin D, HOMA IR, and LH, then correlated and compared between obese and non-obese. Results: 48 samples were included in the study conducted within 3 months. A significant relationship was found between vitamin D and HOMA IR levels in PCOS patients with a p-value of 0.000. There was a significant relationship between vitamin D and LH levels in PCOS patients with a p-value of 0.000. There were significant differences in HOMA IR and LH levels in obese and non-obese PCOS patients, with higher HOMA IR in obese patients with a p-value of 0.001 and higher LH levels in non-obese PCOS patients with a p-value of 0.045. Conclusion: there was a significant relationship between vitamin D levels and HOMA IR and LH in PCOS patients and a significant difference in HOMA IR and LH in obese and non-obese PCOS patients.

OBJECTIVE:To evaluate interleukin (IL)-1β, IL-6, IL-8, and IL-12p70 levels in serum and peritoneal fluid in women related to infertility and pelvic pain. METHODS:Eighty-seven women were diagnosed with endometriosis or cases related to infertility. IL-1β, IL-6, IL-8, and IL-12p70 levels in serum and peritoneal fluid were determined by enzyme-linked immunosorbent assay (ELISA). Pain assessment was evaluated by the Visual Analog Scale (VAS) score. RESULTS:Serum IL-6 and IL-12p70 levels increased in women with endometriosis compared to the control group. Serum and peritoneal IL-8 and IL-12p70 levels correlated with VAS scores in infertile women. A positive correlation was also found between peritoneal IL-1β and IL-6 with VAS score. A significant difference in peritoneal IL-1β levels was associated with menstrual pelvic pain, while peritoneal IL-8 levels were related to dyspareunia, menstrual, and post-menstrual pelvic pain in infertile women. CONCLUSIONS:An association of IL-8 and IL-12p70 levels were related to pain in endometriosis, as well as a relationship between cytokine expression and VAS score. Further studies should be addressed to investigate the precise mechanism of cytokine-related pain in endometriosis.

Introduction: Polycystic Ovary Syndrome (PCOS) is the most prevalent metabolic disease affecting reproductive-age women and is often present with insulin resistance. Angiopoietin-like-protein-2 (ANGPTL2) is an angiogenic factor influencing insulin resistance in PCOS, manifesting in the anti-mullerian hormone (AMH).There are no previous studies regarding the relationship between ANGPTL2 levels and AMH in PCOS. The study aims to analyse the relationship between ANGPTL2 and AMH levels in PCOS and to compare ANGPTL2 and AMH levels between PCOS phenotypes. Methods: This cross-sectional study on 43 women aged 18-40 diagnosed with PCOS according to the Rotterdam criteria. Subjects were recruited consecutively and categorized into four PCOS phenotypes. Serum levels of ANGPTL2 and AMH were measured and analysed by correlation and comparison test using SPSS 26. Results: A total of 43 PCOS samples were included in the study within 4 months. Based on the severity, phenotype A (anovulation, hyperandrogenic and polycystic ovaries) showed the highest levels of ANGPTL2 and AMH. There was no significant difference in ANGPTL2 levels between the PCOS phenotypes. There was a significant difference in AMH levels between phenotypes, where the highest value was between phenotypes A and B. There was a positive correlation between ANGPTL2 and AMH levels. Conclusion: There is a positive relationship between ANGPTL2 and AMH serum levels. The ANGPTL2 serum levels were not significantly different. In contrast, the AMH serum levels significantly differed across the four PCOS phenotypes, with the highest level found in phenotype A.

OBJECTIVES:Chronic inflammation and pelvic adhesion play a critical role in endometriosis-related infertility. Research studies suggest that TGF-β superfamily members, such as soluble endoglin (sEng), growth differentiation factor 15 (GDF-15) and tumor growth factor-beta (TGF-β1) contribute to the regulation of inflammation, angiogenesis and cell adhesion. The objective of this study is to investigate the association between the concentrations of these TGF-β-related members and the clinical parameters of infertile women with endometriosis. MATERIALS AND METHODS:Sixty-five infertile women who underwent laparoscopy were divided into two groups in this study: those who had endometriosis (n = 33) and control subjects with benign gynecologic disorders (n = 32). The levels of TGF-β- related members in peritoneal fluid and serum were evaluated by the enzyme-linked immunosorbent assay (ELISA). Clinical and hematological parameters were documented and analyzed. RESULTS:Endometriosis cases had significantly higher levels of sEng, GDF-15 and TGF-β1 in peritoneal fluid (p<0.0005) compared to control subjects, but not in serum. Moreover, serum GDF-15 level was significantly elevated in the late-stage endometriosis compared to the early-stage group. The levels of three TGF-β related molecules in peritoneal fluid showed positive correlations with rASRM score. Blood neutrophil counts have correlation with the peritoneal sEng concentration. CONCLUSION:Our novel evidence on the elevated concentration of peritoneal sEng and GDF-15 in endometriosis, specifically in the late-stage, may indicate the essential role of TGF-β-dependent signaling in endometriosis. Serum GDF-15 might serve as a candidate biomarker for endometriosis severity. Further studies are warranted to investigate the role and regulation of these molecules in endometriosis.

Introduction: Earlier menopause has been associated with increased risk of cardiovascular disease, osteoporosis, shorter life expectancy and even cognitive decline. There are many factors that cause differences in the age of menopause in women, one of these environmental factors is a history of night shift work as a consequence of a job. It is not yet known whether female medical workers, with a history of night shifts, get earlier menopause.Methods: This case control study was conducted among 57 female night workers of the Dr. Soetomo General Academic Hospital. Data collection was conducted from December 2019 - March 2020. The study sample was postmenopausal health workers (nurse and midwife) and administrators. The instrument used in this study was a list of interview questions. The data was processed using SPSS software release 23.Results: The results show that from 45 children diagnosed with ALL, 53% are of the age ≤ 5 years old, with 58% males and 42% females. 13% of the patients are in the high risk group and 87% are in the standard risk group. Nutritional statuses of patients are 2% of them obese experienced remission after induction phase therapy, 56% normal with 80% of them experienced remission. 40% underweight with 89% of them experienced remission and 11% not experienced remission, 2% malnutrition and experienced remission. There is no correlation between the nutritional status of children with acute lymphoblastic leukemia with the outcome of induction phase (p = 0.798).Conclusion: In conclusion, there is no correlation between nutritional status and remission outcome of patients with ALL in the induction phase of therapy. However, high percentage of underweight patients shows nutrition needs special attention to improve therapy outcomes.

Problem Soluble immune checkpoint molecules constitute the emerging novel mediators in immune regulation. Their role in the pathogenesis of endometriosis has not been fully addressed. In this study, we aimed to investigate the relationship between the clinical manifestation of endometriosis-associated infertility and the level of four soluble immune checkpoints: sCTLA4, sHLA-G, sPD-1, and sPD-L1. Method of study The soluble immune checkpoint concentrations in serum and peritoneal fluid from 88 patients who underwent laparoscopy were evaluated by the enzyme-linked immunosorbent assay (ELISA). Clinical and hematological parameters were documented and analyzed. Results Endometriosis cases were evident to have significantly higher levels of serum sPD-L1 and all four molecules in peritoneal fluid compared to non-endometriosis control. Contrary, no significant differences were found in the concentration of serum sCTLA-4, sHLA-G and, sPD-1 between endometriosis and control group. There were significant positive correlations between serum and peritoneal fluid concentrations of sCTLA-4, sPD-L1, and sHLA-G. Serum sPD-L1 could discriminate endometriosis-related infertility to other pathological control. At a cutoff of 14,61 pg/mL, serum sPD-L1 had a sensitivity of 77% and specificity of 83%. Moreover, sPD-L1 level showed positive correlations with pelvic adhesion score and myeloid cell count. Conclusion The elevated level of sPD-L1 in serum and immune checkpoint molecules in the peritoneal fluid could represent the hallmark of immune regulation in endometriosis. Serum sPD-L1 could serve as a potential noninvasive endometriosis biomarker. Also, the immune compartment related to the local immune checkpoint molecules may be implicated in biological mechanisms underlying endometriosis-related infertility.