Doxycycline is a drug that has been proposed to modify osteoarthritis (OA) progression, in addition to its role as an antibiotic. However, available evidence thus far comprises sporadic reports, with no consensus on its benefits. Hence, this review attempts to analyze the evidence available thus far on the role of doxycycline as a disease-modifying osteoarthritis drug (DMOAD) in knee osteoarthritis. The earliest evidence of doxycycline in OA appeared in 1991 when doxycycline was found to inhibit the type XI collagenolytic activity of extracts from the human osteoarthritic cartilage, and gelatinase and tetracycline were found to inhibit this metalloproteinase activity in articular cartilage in vivo, which could modify cartilage breakdown in osteoarthritis. Apart from the inhibition of cartilage damage by metalloproteinases (MMPs) and other cartilage-related mechanisms, doxycycline also affects the bone and interferes with many enzyme systems. The most significant finding after reviewing various studies was that doxycycline has a definitive role in structural changes in osteoarthritis progression and radiological joint space width, but its role in the improvement of clinical outcomes as a DMOAD has not been established. However, there is much of a gap and lack of evidence in this regard. Doxycycline, as an MMP inhibitor, has theoretical advantages for clinical outcomes, but the present studies reveal only beneficial structural changes in osteoarthritis and very minimal or nonexistent advantages in clinical outcomes. Current evidence does not favor the regular use of doxycycline for the treatment of osteoarthritis as an individual treatment option or in combination with others. However, multicenter large cohort studies are warranted to determine the long-term benefits of doxycycline.

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, and it is a predictor of mental health status that specifically indicates self-esteem, perceived social support, emotion-oriented coping, and a sense of personal mastery. The third gender known better as transgender has existed in every culture, race, class, and religion since the inception of human life has been recorded and analyzed. In spite of many advances and reforms, the current plight of transgender is far from being satisfactory. The social integration of transgender with the mainstream community is practically non-existent even today. The objective of the study is to assess the level of resilience among transgenders at selected areas in Puducherry, India, and to find out the association between the levels of resilience among transgenders with the selected demographic variables. A descriptive cross-sectional study was conducted in the selected areas of Puducherry, India, adopting a linear snowball sampling method after consultation with the Nayaks (heads of transgenders) of the transgender groups, and 100 transgenders were enrolled who fulfilled the inclusion criteria and consented to participate in the research. About 29 (29%) transgenders were in the age group of 31-40 years, 28 (28%) were in the age group of 21-30 years, 24 (24%) were in the group of 41-50 years, and 19 (19%) were in the age group of 51 and above. In education status, 38 (38%) had secondary education, 23 (23%) had primary education, 20 (20%) had higher secondary education, 12 (12%) had graduation and above, and seven (7%) were diploma holders. Moreover, 54 (54%) were employed, and 46 (46%) were unemployed; 81 (81%) were residing in rural areas, and 19 (19%) were residing in urban areas. The study revealed that 53 (53%) of them had average resilience, 28 (28%) had the least resilience, and 19 (19%) had the highest resilience among transgenders. The minimum score was 28.0, and the maximum score was 52.0. The mean score was 42.50 with a standard deviation of 4.61. The median value was 43.0. Transgenders exhibit low and average resilience that reflects poor mental health status among them. The educational status was found to be associated with the level of resilience. Proper education among transgenders would help in improving their resilience and betterment of their life.

This chapter explores resilience among transgender individuals in Puducherry, India, examining the interplay between mental well-being and social challenges. The study assessed resilience levels using the Connor-Davidson Resilience Scale (CD-RISC) among 100 transgender participants. Findings revealed a varied distribution of resilience: 53% exhibited average resilience, 28% demonstrated low resilience, and 19% showed high resilience. The mean resilience score was 42.50 (SD = 4.61), with scores ranging from 28 to 52. The research investigates socio-demographic influences on resilience, including education, employment, and rural-urban residency. Notably, 81% of participants resided in rural areas, 38% had secondary education, and 46% were unemployed, highlighting the economic challenges faced by this community. Mental health outcomes were significant, with 33% experiencing depression, 29.6% suffering from anxiety, and 31.1% reporting suicidal ideation in the past year. The chapter identifies key protective factors enhancing resilience, such as family support, peer networks, and community connectedness. It also explores barriers to resilience, including structural inequalities and social exclusion. Based on these findings, the study proposes targeted interventions focusing on educational opportunities, mental health support systems, and community-based initiatives to improve the quality of life for transgender individuals in Puducherry. This research contributes to the understanding of resilience in marginalized communities and provides actionable insights for policymakers, healthcare providers, and community leaders to foster a more inclusive society.