Background. Silver nanoparticles (AgNPs) are more often used in various products, and consequently the potential deleterious effects associated with exposure to them are of concern. Several lines of evidence have demonstrated that the toxicity of AgNPs affects different organs and leads to some side effects, including weight loss, inflammation and cell death. Objectives. The aim of this study was to evaluate the effect of different concentrations of AgNPs on sperm parameters and testicular histology. Material and methods. In the present study, 28 male adult Wistar rats were categorized into a control group and 3 experimental groups (AgNP-1, AgNP-2 and AgNP-3), intraperitoneally (i.p.) receiving 30, 125 and 300 mg/kg of AgNPs, respectively. Twenty-eight days after injection the epididymes and the testes of each rat were dissected in order to evaluate sperm parameters, sperm chromatin integrity and histomorphometric changes in the testicular tissue. Results. The results showed a significant decrease in sperm count (p < 0.0001), vitality (p < 0.05) and morphology changes (p < 0.001) in the group receiving 300 mg/kg of AgNPs compared to the control group. A significant decrease was also observed in the number of spermatogonia, Sertoli and Leydig cells in the AgNP-2 and AgNP-3 groups (p < 0.05). The evaluation of sperm chromatin did not show any significant differences among the experimental groups (p > 0.05). Conclusions. The data showed some dose-dependent adverse effects of AgNPs on sperm and seminiferous tubules. More experimental investigations are necessary to draw better conclusions regarding the safety of nanoparticles (NPs) on the male reproduction system.

IntroductionEnterococcus is responsible for 10% of hospital-acquired infections. The purpose of this review was to evaluate the prevalence of vancomycin-resistant Enterococcus (VRE) isolates in Iran using a meta-analysis method.Materials and methodsIranian databases, including Magiran and IranDoc, and international databases, including PubMed and MedLib, were examined carefully, and a total of 20 articles published between 2000 and 2011 were extracted. The data were subjected to meta-analysis and random-effects models. In addition, heterogeneous studies were assessed using the I2 index. Finally, the data were analyzed using R and STATA software.ResultsThe results showed that the strain of Enterococcus faecalis had been more common than Enterococcus faecium in clinical infection (69% vs 28%). However, resistance to vancomycin was higher among strains of E. faecium compared with strains of E. faecalis (33% vs 3%). The complete resistance, intermediate resistance, and sensitivity to vancomycin among Enterococcus isolates were 14% (95% CI: 11, 18), 14% (95% CI: 5, 23), and 74% (95% CI: 65, 83), respectively. The resistance patterns, depending on the sample type, did not show a significant difference. In addition, the resistance of isolated strains to vancomycin in outpatients was significantly higher than that in inpatients (16% vs 1%). Moreover, 80%–86% of resistant strains were genotype van A and 14%–20% of resistant strains were genotype van B.ConclusionThe findings of the present review show that there is a high frequency of resistant Enterococcus in Iran. Therefore, consideration of the prevalence and frequency of subjected resistant strains can be helpful for decision makers to implement proper health policies in this direction.

IntroductionMedical students have a serious need to acquire communication skills with others. In many medical schools, special curriculums are developed to improve such skills. Effective training of communication skills requires expert curriculum design. The aim of this study was to explore the experiences and views of experts and stakeholders in order to design a suitable training program in communication skills for medical students.MethodsThe content analysis approach was used in this qualitative study. Forty-three participants were selected from the faculty, nurses, physicians, residents, and medical students at Mashhad University of Medical Sciences using purposive sampling. The data were collected through focus group discussions and semi-structured interviews. To ensure the accuracy of the data, the criteria of credibility, transferability, dependability, and conformability were met. The data were analyzed by MAXQDA software using the Graneheim & Lundman model.ResultsThe findings of this study consisted of two main themes, i.e., “The vast nature of the present communication skills training” and “administrative requirements of the training program regarding communication skills.” The first theme included the educational needs of students, the problems associated with training people to have good communication skills, the importance of good communication skills in performing professional duties, communication skills and job requirements, the learning environment of communication skills, and the status of existing training programs for communication skills. Strategies and suitable methods for teaching communication skills and methods of evaluating the students in this regard also were obtained.ConclusionThe findings of this study were the elements required to design a proper and local model to teach communication skills to medical students through analyzing the concepts of effective communication. The results of this study can be useful for medical faculties in designing a proper program for teaching medical students how to communicate effectively with patients and colleagues.

Background: To date, comprehensive data on drug utilization in Iranian people are lacking. The purpose of this study was to graphically describe drug prescription, polypharmacy, and pharmaceutical spending in > 3 million Iranian elderly people. Methods: In this multilevel cross-sectional study, using administrative claims data provided by the Iran Health Insurance Organization (IHIO), we assessed drug claims and drug costs in 2018 in >3 million individuals living in Iran and who have been insured with health insurance (Bimeh Salamat). In particular, we analyzed the prevalence of polypharmacy and pharmaceutical spending use according to the annual Report of Iranian Health Insurance Organization. Multilevel ordinal logistic and multilevel beta regression models were used to analyze the data. Significance level was set as P ≤ .05 and CI at 95%. Results: Nationally, the mean number of drug prescriptions per patient was 1.46 (SD, 0.81). The mean number of prescribed drugs per patient was 4.32 (SD, = 3.04). The drug cost for each elderly patient was $6.86 (interquartile range (IQR), 12.26), with $4.96 and $1.76 for the insurance and the insured shares, respectively. For elderly women, the odds of polypharmacy (excessive and nonexcessive vs no polypharmacy) were 1.164 (95% CI, 1.142 to 1.186) times that of elderly men. In addition, in the spring season, the odds of polypharmacy were 1.274 (95% CI, 1.241 to 1.309) times that of the winter. Similarly, polypharmacy was strongly higher among patients who had noncommunicable diseases (OR, 2.174; 95% CI, 2.069 to 2.275 (P < 0.001)). Conclusion: The high prevalence of hyper prescription in Iran elderly people may indicate a need for interventions aiming at deprescribing drugs with an unfavorable benefit-risk profile. The best practice guidelines should be developed for improved medical practice in the prescription of medications for such a vulnerable population.

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