Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices. PCOS is commonly associated with a high prevalence of insulin resistance and obesity; this association carries an increased risk of developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. Guidelines recommend lifestyle modification, metformin, hormonal contraceptives (HCs), and bariatric surgery as the main treatment options in obese patients with PCOS. Studies are being conducted to test the efficacy of existing treatment options as well as to discover new therapies. This review focuses on the most recent advances in this regard and highlights new hypotheses and emerging studies to give a picture of the latest therapeutic trends in the treatment of obese patients with PCOS. In this respect, much attention is given to the role of inositols, the mediators of insulin action. A deficiency of d-chiro-inositol containing inositol-phospho-glycans may be the basis of insulin resistance frequently seen in PCOS patients. Moreover, evidence suggests the use of statins in obese women with PCOS, but guidelines call for further research. Adiponectin, quercetin, vitamin D, and anti-obesity drugs have also been studied and seem to have a useful role in the treatment of obesity and metabolic syndrome in PCOS. Many trials have been conducted on the use of non-pharmacological therapies. Therapies including resveratrol, acupuncture, and berberine have favorable effects in overweight PCOS patients. However, more research is needed to reveal the clinical complexity of PCOS and develop more effective treatment options.

Nanoparticles (NPs) are being recognized as antibacterial agents due to their rapidly increasing multidrug resistance in bacterial pathogens. Hence, there is an unmet need to identify the natural antibacterial agent. The present study aimed to evaluate the antibacterial activity of sericin-conjugated silver NPs synthesized by using sericin as a reducing and capping agent. Synthesized NPs were characterized by scanning electron microscope, nanolaser particle size analyzer (BT-90), Fouriertransform infrared analysis, and energy-dispersive X-ray. The biogenic NPs significantly inhibited the growth of Escherichia coli (12-15 mm zone of inhibition), Staphylococcus aureus (14.6-15.4 mm zone of inhibition), and Klebsiella pneumoniae (12.5-18 mm zone of inhibition). The stability of naturally synthesized NPs was examined at various temperatures (i.e., 4°C, 37°C, and 55°C) and pH (i.e., 3, 7, and 11). Temperature variability did not significantly affect the efficacy of NPs. However, NPs performed better at higher pH levels. This study suggested that the sericinbased silver NPs are not only effective against bacteria, but they also maintain the stability at different ranges of temperature and pH. We concluded that the sericinconjugated silver NPs possess the remarkable antibacterial potential, which suggests their large-scale use as a cheap and stable antimicrobial agent in the future. K E Y W O R D Santibacterial activity, nanoparticles, sericin, silver

Transgender or gender dysphoria has been defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as distress resulting from the incongruence between one’s experienced gender and one’s assigned gender, along with a persistent and strong desire to be of another gender, and accompanied by clinically significant distress. Adolescents referred for evaluation often want hormonal therapy and several among them also express a desire for gender reassignment surgery. Furthermore, evidence shows that adolescents and adults with gender dysphoria without a sex development disorder, before gender reassignments, are at increased risk for suicide. For this review, a search of the English language scientific literature was conducted using the PubMed database. This summary discusses the associations and comorbidities of gender dysphoria and reiterates the evidence that its etiology is multifactorial. Transsexualism involves prenatal neuroanatomical changes, has a psychiatric association, and is found to be more prevalent in conjunction with schizophrenia and autism spectrum disorders. Childhood adversities and neglect are also linked to having a transgender identity. Moreover, the evidence favors a genetic predisposition. Likewise, there seems to be a growing concern with regards to the relationship between endocrine disruptors and transsexuals as well as other gender minority populations. More research needs to be done to understand the exact pathways.

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Sodium-glucose co-transporter 2 inhibitors (SGLT2is) such as dapagliflozin, canagliflozin, and empagliflozin, are a promising new therapy in the treatment of type 2 diabetes mellitus (T2DM). SGLT2is can effectively reduce hyperglycemia thus improving glycemic control and they offer some beneficial effects on the cardiovascular (CV) system which can benefit patients with heart failure in addition toT2DM. The United States Food and Drug Administration requires new diabetes mellitus therapies to show a CV safety profile. Empagliflozin was the first SGLT2i that, when added to the standard of care for patients withT2DM at high risk for CV events, showed improved CV outcomes including reduced deaths from CV causes. Evidence also exists in favor of dapagliflozin for use in patients with T2DM with CV risk factors and heart failure. This review focuses on the effects, safety, and benefits of dapagliflozin on the CV system. Clinical trials have shown that dapagliflozin improves glycemic control without variation. It is safe and well-tolerated in the general population including older patients and those with high-risk CV factors or preexisting CV disease. There may be a renal protective role by an unknown mechanism. Dapagliflozin also lowers blood pressure due to its natriuresis effect. It improves levels of visceral fat and reduces body weight, and thus ameliorates metabolic syndrome. Dapagliflozin reduces oxidative stress and may delay atherosclerosis. Recent findings indicate SGLT2is may also reduce the atrial natriuretic peptide levels. Additional trials are required to validate these benefits and further evaluate if these are class effects. Trials such as DECLARE-TIMI58 are ongoing to evaluate the CV outcomes of dapagliflozin. More research is needed to design better antihyperglycemic regimes with clinical benefits in addition to good glycemic control.

The polypyrrole (PPY/TW) and magnetic (MG/TW) composite with tea waste (TW) was prepared and used as an adsorbent for PO43− ions removal from aqueous media. The composite were characterized with SEM and FTIR techniques. Batch study was conducted to investigate the effect of different reaction parameters on the adsorption of PO43− ions. The native TW, PPY/TW, and MG/TW showed the PO43− ions removal of 7.2, 7.3, and 7.9 (mg/g), respectively, using 0.05 g adsorbent dose and 10 mg/L initial concentration of PO43− ions at pH of 6, 10, and 3, respectively, and equilibrium was reached in 90 min. Kinetics and isotherm models were employed on the PO43− ions adsorption data and PO43− ions adsorption followed the pseudo-second order kinetics, intraparticle diffusion, and Langmuir isotherm models. Thermodynamics analysis reveals an exothermic process and spontaneous adsorption of PO43− ions on the composites. Results revealed that the magnetic and polypyrrole composites with tea waste have auspicious potential as an adsorbent and this class of the composites can be utilized for the removal of PO43− ions from the effluents.

Introduction: The clinical heterogeneity and unpredictable clinical course of mitochondrial respiratory chain (MRC) disorders has hindered the development of effective therapeutic strategies for the treatment of these diseases. Treatment generally involves supportive therapy aimed at enhancing mitochondrial function as well as ameliorating increased reactive oxygen species (ROS) generation which is associated with MRC dysfunction. The purpose of this review is to focus on current biochemical strategies together with those that are being developed to treatment of MRC disorders. Areas covered: This review focusses on the biochemical strategies that have been developed to augment MRC function (increase electron transport and substrate availability in the MRC), scavenge ROS (antioxidant therapies) and modify mitochondrial biogenesis will be covered. The authors have comprehensively reviewed the literature to provide up to date information on these subjects. Expert opinion: A consensus needs to be reached on the treatment of MRC disorders, and rather than the use of generic `antioxidant cocktails` case specific therapeutic strategies should be considered for the treatment patients. The inclusion of pharmacotherapies that target MRC function, cellular antioxidant status and mitochondrial biogenesis in the treatment regime of patients may be appropriate to ameliorate the defects in these parameters that contribute to disease pathophysiology. Article highlights  Mitochondrial respiratory chain (MRC) disorders are a complex group of diseases that have a heterogeneous clinical presentation and disease course creating formidable challenges for their effective treatment management.  The majority of therapeutic strategies available for the treatment of MRC disorders focus upon enhancing the activity of the MRC and restoring cellular antioxidant status.  Pharmaceutical agents that are capable of stimulating mitochondrial biogenesis and in some cases reversing MRC enzyme deficiencies have received a lot of attention over recent years with some of these compounds now entering clinical trials.  At present there is no consensus or unified approach to the treatment of MRC disorders and therapeutic strategies can vary between countries and specialist centres. Information Classification: General  Candidate therapies should be determined on a case specific basis. Furthermore, it may be appropriate to include pharmaceutical agents that target MRC function, cellular antioxidant status and mitochondrial biogenesis in the treatment regime of patients in view of the involvement of all of these parameters in disease pathophysiology.

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