Safeera Khan

Obesity is a prominent health issue across the globe that causes negative reproductive consequences like decreased fertility. Even its effects on the success of in vitro fertilization (IVF) have drawn interest, with some studies indicating that BMI was linked to IVF failure. In this systematic review, we attempt to bring together the data regarding the impact of obesity on IVF outcomes. It also intends to quantify the adverse effects of female partner obesity on key IVF measures such as implantation, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR), and to understand the mechanism of these adverse effects in obese women.A literature search was undertaken in PubMed/Medline, PubMed Central, Cochrane Library, Science Direct, and MDPI for studies comparing the effects of obesity (BMI ≥ 30 kg/m²) on IVF results. These studies included randomized controlled trials, cohort studies, case studies, literature reviews, and case-control studies. From the databases, we were able to select 533 relevant articles. The studies were evaluated, eligibility standards were followed, and 13 papers were considered. We collected data, and analyses of implantation rates, CPR, LBR, and MR were narratively reviewed because the studies were heterogeneous. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the quality was assessed using the Cochrane Risk of Bias 2 scale for randomized trials and the Newcastle-Ottawa Scale for observational studies.A total of 13 studies, including participants, were included in the analysis. Obesity was consistently correlated with lower implantation, reduced CPR and LBR, and higher MR than women with normal BMI. To be precise, every five-unit increase in BMI was associated with a 5-7% reduction in CPR and LBR and a 9% rise in MR, underscoring the significant impact of obesity on IVF outcomes. In terms of mechanisms, metabolic disturbances in the oocytes, reduced endometrial response, and chronic inflammation were identified as the primary causes of these poor outcomes in obese women. In addition, interventions to reduce weight, such as diet and bariatric surgery, had an impact on the success of IVF.Obesity has a significant negative effect on IVF success, both in terms of oocyte quality and endometrial responsiveness. In overweight women who are seeking fertility treatment, weight control must be part of preconception treatment. However, further studies are needed to determine effective weight loss interventions and to better understand the mechanisms underlying IVF success in this group.

Hidradenitis suppurativa (HS) is a long-standing inflammatory skin condition with inflammatory nodules, abscesses, and sinus tracts. Tumor necrosis factor-alpha (TNF-alpha) inhibitors like Adalimumab are one of the first-line therapies approved for use in moderate-to-severe HS, but despite that, there is no consensus on what objective biomarkers can be employed to monitor treatment efficacy. This systematic review aims to explain the utility of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as reliable indicators of treatment response to HS. Our objective was to determine if, in patients with HS, treatment with TNF-alpha inhibitors (e.g., adalimumab) leads to a significant change in systemic inflammatory markers like CRP and ESR. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Subsequently, a systematic search was conducted across databases like PubMed/MEDLINE, PMC, ScienceDirect, Cochrane Library, and Clinical Trials, focusing on studies published within the last five years. Search terms included "hidradenitis suppurativa," "adalimumab," and "infliximab." Included studies underwent rigorous quality appraisal with appropriate quality assessment tools, finally resulting in the analysis of only the relevant articles.The evidence confirms that adalimumab therapy leads to a statistically significant reduction in CRP levels, mainly due to its systemic anti-inflammatory effect. However, the clinical value of CRP is questionable, as it is susceptible to confounding by obesity and metabolic syndrome, which are also highly prevalent comorbidities found in HS patients. In contrast, ESR is also proposed as a theoretically superior biomarker, one of the reasons being that it has less interference from these confounders. Our review highlighted a significant lack of prospective data evaluating ESR and CRP changes in response to TNF-alpha inhibitor therapy. A prominent trend was also noticed in recent clinical trials within the past five years to prioritize clinical checkpoints, such as the Hidradenitis Suppurativa Clinical Response (HiSCR), over serological markers.Overall, our systematic review showed that CRP is not a perfect biomarker for monitoring individual treatment response, which is in part due to various confounding factors, such as obesity affecting its level. ESR represents a promising but as yet unvalidated alternative. Currently, the most useful strategy may be a hybrid approach that integrates clinical scores (e.g., HiSCR, International Hidradenitis Suppurativa Severity Score System [IHS4]) with the simultaneous use of inflammatory markers. Our review highlights a critical need for future research to evaluate and compare CRP and ESR to establish their definitive roles in guiding HS therapy.