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Rohullah Roien,1 Sayed Hamid Mousavi,1 Akihiko Ozaki,2,3 Sayed Abulqasem Baqeri,1 Sayed Mohammad Reza Hosseini,1 Shoaib Ahmad,4 Sunil Shrestha5,6 1Medical Research Centre, Kateb University, Kabul, Afghanistan; 2Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan; 3Medical Governance Research Institute, Tokyo, Japan; 4Department of Pediatrics, District Head Quarters Teaching Hospital, Faisalabad, Pakistan; 5Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Province Bagmati, Nepal; 6Nobel College Faculty of Health Sciences, Pokhara University, Kathmandu, Province Bagmati, NepalCorrespondence: Rohullah Roien; Sayed Hamid Mousavi Email Rohullahroien@kateb.edu.af; Dr.mousavi@kateb.edu.afBackground: Hepatitis B virus (HBV) infection is a serious public health issue around the world. Health care workers (HCWs) are at high risk of HBV infection because they have direct contact with HBV infected blood and body fluids in their work.Objective: The purpose of this study was to evaluate the knowledge, attitude, and practice (KAP) of HCWs towards hepatitis B infection in Kabul, Afghanistan.Methods: This cross-sectional study was conducted on 502 HCWs, between November 2018 and January 2019 by a simple random sampling method. The data was collected through a self-administered structured questionnaire. Using this questionnaire, demographic characteristics and KAP of HCWs was assessed. In addition, descriptive and inferential analyses was conducted on the collected data using SPSS 16 (SPSS Inc., Chicago, IL, USA).Results: The overall KAP scores of HCWs were found to be 86.58%, 34.73%, and 61.22%, respectively. Most of the participants correctly recognized the HBV infection. Among the participants, only 77.45% had undergone screening for HBV, and 56.37% had received HBV vaccine (p < 0.0001). Moreover, only 6.77% had completed the three doses of vaccination for HBV. Among the HCWs, the group with higher education level had better knowledge than the group with lower education level. However, the attitude of most of the participants towards HBV prevention was found to be inadequate (53.98%).Conclusion: This study shows that HCWs in Kabul, Afghanistan are at high risk of HBV infection due to low vaccination coverage and inadequate infection control. Therefore, we strongly encourage providing an accessible and compulsory vaccination program for all HCWs to improve their attitude and awareness towards HBV infection and to achieve effective infection control.Keywords: hepatitis, hepatitis B virus, Kabul, health care worker

Background: The aim of this study was to compare the complications of percutaneous nephrolithotomy (PCNL) surgery in Flank and Prone positions in patients with a BMI above 30. Methods: In this randomized clinical trial patients were randomly assigned to PCNL treatment in one of two groups undergoing PCNL under fluoroscopic guidance in Flank or Prone positions. Patient demographic information, stone number, size and location, stent duration, hospital stay, blood loss, Creatinine, hemoglobin, hematocrit changes, and arterial blood gas changes and acid-base hemostasis were collected. Results: In this study, 60 patients were examined, which were divided into two groups of 29 people, prone and 31 people. Mean stone size was 3.16 ± 0.82 cm. arterial blood gases did not differ significantly between two groups. The SFR (stone free rate) in the prone and flank groups was 91.02% and 86.89%, respectively. However, SFR and Complications in the prone and flank groups were not significantly different ( p value of 0.081 and 0.13, respectively). Conclusions: According to the results of this study, PCNL complications and acid-base changes is not significantly different in flank and prone positions in obese patients. However, SFR is slightly lower in flank group. Thus, PCNL in flank position is not superior to prone position in obese Patients. It is recommended to choose each of these surgical methods according to the surgeon’s facilities and skills.

Aim: Although clinicians primarily diagnose dementia based on a combination of metrics such as medical history and formal neuropsychological tests, recent work using linguistic analysis of narrative speech to identify dementia has shown promising results. We aim to build upon research by Thomas JA & Burkardt HA et al. (J Alzheimers Dis. 2020;76:905–2) and Alhanai et al. (arXiv:1710.07551v1. 2020) on the Framingham Heart Study (FHS) Cognitive Aging Cohort by 1) demonstrating the predictive capability of linguistic analysis in differentiating cognitively normal from cognitively impaired participants and 2) comparing the performance of the original linguistic features with the performance of expanded features. Methods: Data were derived from a subset of the FHS Cognitive Aging Cohort. We analyzed a sub-selection of 98 participants, which provided 127 unique audio files and clinical observations (n = 127, female = 47%, cognitively impaired = 43%). We built on previous work which extracted original linguistic features from transcribed audio files by extracting expanded features. We used both feature sets to train logistic regression classifiers to distinguish cognitively normal from cognitively impaired participants and compared the predictive power of the original and expanded linguistic feature sets, and participants’ Mini-Mental State Examination (MMSE) scores. Results: Based on the area under the receiver-operator characteristic curve (AUC) of the models, both the original (AUC = 0.882) and expanded (AUC = 0.883) feature sets outperformed MMSE (AUC = 0.870) in classifying cognitively impaired and cognitively normal participants. Although the original and expanded feature sets had similar AUC, the expanded feature set showed better positive and negative predictive value [expanded: positive predictive value (PPV) = 0.738, negative predictive value (NPV) = 0.889; original: PPV = 0.701, NPV = 0.869]. Conclusions: Linguistic analysis has been shown to be a potentially powerful tool for clinical use in classifying cognitive impairment. This study expands the work of several others, but further studies into the plausibility of speech analysis in clinical use are vital to ensure the validity of speech analysis for clinical classification of cognitive impairment.

This is a comprehensive systematic review and dose–response meta-analysis evaluating the effects of oral magnesium supplementation on inflammatory biomarkers including C-reactive protein (CRP), interleukin‐6 (IL‐6), and tumor necrosis factor-alpha (TNF‐α) among adults. The major databases including PubMed, Web of Science, Embase, and Google Scholar were searched for relevant publications until December 14, 2020, using appropriate keywords. The Cochrane Collaboration tool was used to assess the quality of each study. We also performed a subgroup analysis to identify probable sources of heterogeneity. A total of 18 studies with 927 participants fulfilled the eligibility criteria and included in this meta-analysis. Our results indicate that the supplementation with magnesium had no statistically significant effect on serum concentrations of CRP (WMD, − 0.49; 95% CI, − 1.72 to 0.75 mg/L; P = 0.44), IL-6 (WMD, − 0.03; 95% CI, − 0.40 to 0.33 pg/mL; P = 0.86), and TNF‐α (WMD, 0.12; 95% CI, − 0.08 to 0.31 pg/mL; P = 0.24) compared with controls. In addition, based on dose–response assessment, no significant non-linear association was found between magnesium supplementation dosage or duration on serum CRP and IL-6 concentrations. The findings of the present systematic review and meta-analysis did not support the notion that oral magnesium supplementation could have favorable effects on CRP, IL-6, and TNF-α in the adult population.

Objective:Community responses are important for the management of early-phase outbreaks of coronavirus disease 2019 (COVID-19). Perceived susceptibility and severity are considered key elements that motivate people to adopt nonpharmaceutical interventions. This study aimed to (i) explore perceived susceptibility and severity of the COVID-19 pandemic, (ii) examine the practice of nonpharmaceutical interventions, and (iii) assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions among people living in Afghanistan.Methods:A cross-sectional design was used, using online surveys disseminated from April to May 2020. Convenience sampling was used to recruit the participants of this study. The previously developed scales were used to assess the participants’ demographic information, perceived risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and perceived severity of COVID-19. Multivariate analyses were conducted to assess the potential association of perceived COVID-19 susceptibility and severity with the practice of nonpharmaceutical interventions.Results:The Internet was the main source for obtaining COVID-19 information among participants in this study. While 45.8% of the participants believed it was “very unlikely” for them to get infected with COVID-19, 76.7% perceived COVID-19 as a severe disease. Similarly, 37.5% believed the chance of being cured if infected with COVID-19 is “unlikely/very unlikely.” The majority of participants (95.6%) perceived their health to be in “good” and “very good” status. Overall, 74.2% mentioned that they stopped visiting public places, 49.7% started using gloves, and 70.4% started wearing a mask. Participants who believed they have a low probability of survival if infected with COVID-19 were more likely to wear masks and practice hand washing.Conclusions:It appears that communities’ psychological and behavioral responses were affected by the early phase of the COVID-19 pandemic in Afghanistan, especially among young Internet users. The findings gained from a timely behavioral assessment of the community might be useful to develop interventions and risk communication strategies in epidemics within and beyond COVID-19.

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), has been the world’s driving fatal bacterial contagious disease globally. It continues a public health emergency, and around one-third of the global community has been affected by latent TB infection (LTBI). This is mostly due to the difficulty in diagnosing and treating patients with TB and LTBI. Exosomes are nanovesicles (40–100 nm) released from different cell types, containing proteins, lipids, mRNA, and miRNA, and they allow the transfer of one’s cargo to other cells. The functional and diagnostic potential of exosomal miRNAs has been demonstrated in bacterial infections, including TB. Besides, it has been recognized that cells infected by intracellular pathogens such as Mtb can be secreting an exosome, which is implicated in the infection’s fate. Exosomes, therefore, open a unique viewpoint on the investigative process of TB pathogenicity. This study explores the possible function of exosomal miRNAs as a diagnostic biomarker. Moreover, we include the latest data on the pathogenic and therapeutic role of exosomal miRNAs in TB.

Background. The prevalence of obesity and metabolic syndrome (MetS) is increasing, worldwide. Using a simple, efficient and reliable tool for predicting MetS is an essential approach in preventive health programs. The aim of this study was to compare the different anthropometric indices in predicting metabolic syndrome in older adults. Methods. This cross-sectional study is a part of the Amirkola Health and Ageing cohort Project (2011–2016). Of total, 1,488 older people aged 60–92 years were entered to the study. Medical and personal information of participants were collected by a questionnaire. After measuring the height, weight, waist circumference, hip circumference and neck circumference, body mass index, waist to hip ratio, waist to height ratio, abdominal volume index and conicity index were calculated. Independent t-test, chi-square and ROC curve were used to analyze the data. Results. Based on ATPIII-2005 diagnostic criteria, the prevalence of metabolic syndrome was 71.57%.The prevalence in female was higher than male. All of examined anthropometric indices, except neck circumference (p = 0.10), showed a significant difference in people with MetS compared to the individuals without metabolic syndrome (p Conclusion. Waist to height ratio was the best predictor of MetS in older adults.

Hepatic steatosis is an early form of non-alcoholic fatty liver disease (NAFLD), caused by abnormal fat deposition in the hepatocytes. Conjugated linoleic acid (CLA) is a group of positional and geometric dienoic isomers of linoleic acid that attract significant attention because of its beneficial effects on chronic diseases such as cancer, obesity, and metabolic syndrome. This study examined the influence of a mixture of two main CLA isomers (CLA-mix) on lipid accumulation and lipid metabolism-related genes using HepG2 cells treated with palmitic acid (PA) as an in vitro model for hepatic steatosis. Methods and Results: HepG2 cells were treated for 24 h: control (BSA), model (BSA + PA), and treated groups (BSA-PA + non-toxic concentrations of CLA-mix). Intracellular lipid deposition, triglyceride (TG), total cholesterol (TC) and gene expression were measured by Oil-Red O staining, colorimetric assay kits and real-time PCR, respectively. CLA-mix at high concentrations had significantly decreased intracellular total lipid and TG deposition compared to the model group. However, none of the CLA-mix concentrations had a significant effect on the intracellular TC level. CLA-mix significantly increased the expression of some genes mainly regulated by PPARα but did not alter the expression of lipogenesis-related genes. Conclusions: These results demonstrate that high concentrations of CLA-mix protect against hepatic steatosis and play a role in regulating fatty acid oxidation and bile excretion through the PPARα pathway. It is suggested that the effect of different ratios of two main CLA isomers on the amount and ratio of bile compounds be investigated in future studies.

Aim: Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include neuroimaging or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. This study explores the use of BrainCheck Sport, a computerized neurocognitive test that is available on iPad, iPhone, or computer desktop, for mTBI assessment. The BrainCheck Sport Battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination. Methods: We administered BrainCheck Sport to 10 participants diagnosed with mTBI at the emergency department of Children’s hospital or local high school within 96 hours of injury, and 115 normal controls at a local high school. Statistical analysis included Mann-Whitney U test, chi-square tests, and Hochberg tests to examine differences between the mTBI group and control group on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from control participants. Results: BrainCheck Sport was able to detect significant differences in Coordination, Stroop, Immediate/Delayed Recognition between normal controls and mTBI patients. Receiver operating characteristic (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 81%, with an area under the curve of 0.884. Conclusions: BrainCheck Sport has potential in distinguishing mTBI from control participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.

Background: The prevalence and severity of tooth decay have shown a significant increase in the past 20 years. This study evaluated the relationship between the amount of tooth decay and body mass index (BMI) in 6-12 year-old children in Ilam during 2016-2017. Methods: The population of this cross-sectional study consisted of 270 female and 250 male students in Ilam. Their weight and height and BMI were measured for each individual and the information on the examination of children’s teeth was inserted into relevant tables. Other research data (i.e., dietary habits, oral health instruction, and socioeconomic conditions) were gathered using a valid and reliable questionnaire. Results: There was no significant relationship between the amount of tooth decay and BMI among 6-12 children in Liam. Except for the 11-year-old (n=86) group demonstrating an inverse relationship between dmft and BMI (r = -0.185), an inverse relationship was found between the decay and observation of health although there was a direct relationship between the consumption of sugar materials and tooth decay. Conclusions: The results of the study revealed no significant relationship between the amount of tooth decay and BMI among 6-12 children in Ilam except for 9-year-old and 11-year-old groups.

Background There is a need for fast, accessible, low-cost, and accurate diagnostic methods for early detection of cognitive decline. Dementia diagnoses are usually made years after symptom onset, missing a window of opportunity for early intervention. Objective To evaluate the use of recorded voice features as proxies for cognitive function by using neuropsychological test measures and existing dementia diagnoses. Methods This study analyzed 170 audio recordings, transcripts, and paired neuropsychological test results from 135 participants selected from the Framingham Heart Study (FHS), which includes 97 recordings of cognitively normal participants and 73 recordings of cognitively impaired participants. Acoustic and linguistic features of the voice samples were correlated with cognitive performance measures to verify their association. Results Language and voice features, when combined with demographic variables, performed with an AUC of 0.942 (95% CI 0.929-0.983) in predicting cognitive status. Features with good predictive power included the acoustic features mean spectral slope in the 500-1500 Hz band, variation in the F2 bandwidth, and variation in the Mel-Frequency Cepstral Coefficient (MFCC) 1;the demographic features employment, education, and age; and the text features of number of words, number of compound words, number of unique nouns, and number of proper names. Conclusion Several linguistic and acoustic biomarkers show correlations and predictive power with regard to neuropsychological testing results and cognitive impairment diagnoses, including dementia. This initial study paves the way for a follow-up comprehensive study incorporating the entire FHS cohort.

Background and purpose: Type 2 diabetes mellitus (T2DM) is the most common form of diabetes, and a metabolic disorder affecting patients' general health in various ways. The present study aimed to evaluate the oral health-related quality of life (OHRQoL) among older adults of Amirkola, Northern Iran. Materials and Methods: A case-control study was conducted with a sample of 500 elderly people (250 with T2DM and 250 healthy controls) who answered geriatric oral health assessment index (GOHAI) questionnaire and a questionnaire evaluating xerostomia. Then, all participants underwent clinical dental examinations. The obtained data were then analyzed by t-test, chi-square test, and Pearson's correlation coefficient, and p < 0.05 was considered significant. Results: The prevalence of xerostomia was not statistically significant between the T2DM patients and control groups (p < 0.079). Greater number of patients suffering T2DM reported xerostomia according to the records; however, the correlation between this disorder and periodontal disease index (PDI), Plaque index (PI), oral health index-simplified (OHI-S), and geriatric oral health assessment index (GOHAI) in the subjects of the two study groups was not significant (p < 0.0001). Conclusion: In the present study, there was no significant relationship between GOHAI and periodontal indices, demonstrating no difference in the OHRQoL of elderly patients with T2DM and older healthy adults.

Expanding the service life length of wooden made furniture, and consequently decreasing the demand for raw wood could help the economy of the world society and environmental safety. In this research, an experimental inquiry was conducted to determine the effects of curved members, the frame integrity, chair scheme, and rehabilitation of even the failed chairs on the behavior of chairs. The flexural properties of the curved specimens were firstly determined using the ASTM D143-94 test. Then, three layouts of chairs (A, B, and C) made from poplar wood were examined under the DIN EN-1729-1&2 standard. Finally, the failed chairs were rehabilitated using the sheets of glass fiber-reinforcing polymers (GFRP) and re-tested. The results showed that the rehabilitation of the curved samples causes rebounding of their mechanical properties. Besides, the rehabilitated samples are more flexible than primary ones. Furthermore, the results demonstrate that the capability of the proposed normalized modulus of rupture (NMOR) criterion, in contrast to the current modulus of rupture (MOR) one, for predicting the failure modes and regions of the wooden and composite structures. The experiments on the chairs showed that all rehabilitated patterns are more robust than primary schemes. That means, the discarded (or discarding) chairs (due to failure of joints, legs, or, in general, a part of the chairs) return to their service life, and massively reduce the demand for wood, which is strongly favored by environmental aspects. Moreover, rehabilitated layout B (RB), which has two continuous-main-curved members is at least 2.4 times stronger than other rehabilitated patterns, and rehabilitated layout C (RC) having three continuous-main-curved members is about 40% stronger than a rehabilitated custom chair (RA), that illustrates more integrity and strength. Besides that, the strength of RB is 2.22 and 2.04 times that of the corresponding primary chairs, depending on front-to-back and up-to-down loading, respectively. Finally, univariate analyses of variance and least significant difference (LSD) showed the high precision of the results. Consequently, the research provides a facility not only to save original material resources, but also to eliminate furniture waste going in the landfill.

Background In the aging individuals, osteoporosis is a major health problem. Due to the various limitations of dual X-ray absorptiometry (DEXA) for diagnosis osteoporosis, serum-based biochemical markers have been suggested for the discrimination between the patients and healthy subjects. Objective To investigate the serum levels of bone turnover markers in elderly osteoporosis patients. Methods The serum samples from elderly subjects (osteoporosis (n = 28), osteopenia (n = 28), and healthy ones (n = 28) were collected from Amirkola Health and Ageing Project study. Furthermore, serum levels of bone formation and bone resorption markers as well as estrogen and progesterone were measured by enzyme-linked immunosorbent assay. Kruskal–Wallis test and receiver operating characteristic curve analysis were used for statistical analysis using SPSS. Results Levels of bone alkaline phosphatase (B-ALP) and procollagen type I N-terminal propeptide (PINP) differed between groups (P = 0.003 and 0.009, respectively). Furthermore, PINP and B-ALP levels had the best area under the curve, sensitivity, and specificity for the discrimination between patients with osteoporosis and healthy individuals. Conclusion In conditions in which we are not able to assess the bone mineral density by DEXA, analysis of the B-ALP and PINP levels may be a helpful tool.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged as a health problem worldwide. It seems that COVID-19 is more lethal for Iranian veterans with a history of exposure to mustard gas. There are some similarities in the pathogenesis of SARS-CoV-2 and mustard gas in immune system disruption and pulmonary infection. SARS-CoV-2 and mustard gas inducing oxidative stress, immune system dysregulation, cytokine storm, and overexpression of angiotensin-converting enzyme II (ACE2) receptor in lungs that act as functional entry receptors for SARS-CoV-2. Moreover, Iranian survivors of mustard gas exposure are more susceptible and vulnerable to COVID-19. It is suggested that the principles of COVID-19 infection prevention and control be adhered to more stringently in Iranian survivors of mustard gas exposure than others who have not been exposed to mustard gas. Therefore, in this review, we discuss the different pathologic aspects of lung injury caused by mustard gas and also the relationship between this damage and the increased susceptibility of Iranian mustard gas exposed survivors to COVID-19.

In this study, we aimed to systematically review the literature to evaluate the effects of magnesium (Mg) supplementation on blood pressure (BP) and obesity measure among patients with type 2 diabetes mellitus (T2DM). Major electronic databases of Web of Science, the Cochrane library, PubMed, and Scopus were searched completely from the inception until 15 October 2019 to identify randomized clinical trials (RCTs) pertaining to the topic of interest. All outcomes were pooled using a random-effects model and expressed as weighted mean differences (WMD) with 95% confidential intervals (CI). Heterogeneity, sensitivity analysis, and publication bias were also assessed using standard methods. The pooled analysis of five RCTs showed that Mg supplementation did not affect body weight (WMD: − 0.01 kg, 95% CI: − 0.36 to 0.33), BMI (WMD: − 0.07, 95% CI: − 0.18 to 0.04), and waist circumference (WMD: 0.12, 95% CI: − 1.24 to 1.48) in T2DM patients compared to the control groups of the patients who received placebo. However, pooling seven RCTs together showed significant reduction of systolic blood pressure (WMD: − 5.78 mmHg, 95% CI: − 11.37 to − 0.19) and diastolic blood pressure (WMD: − 2.50 mmHg, 95% CI: − 4.58 to − 0.41) in T2DM patients. Furthermore, subgroup analysis by dose of intervention, intervention duration, and type of intervention suggested that Mg supplementation for > 12 weeks, in doses higher than 300 mg/day or inorganic forms, could significantly decrease both systolic and diastolic BP in T2DM patients. Based on the findings, Mg supplementation has beneficial effects on BP in type 2 diabetes patients independent of body weight status. However, further investigations are needed to provide more reliable evidences.

Introduction: This study aimed to investigate the effect of head and neck stabilization exercises on improving balance in older adults with forward head posture. Materials and Methods: Thirty elderly participants with forward head posture and Mean±SD age of 65.7±5.2 years were examined. The forward head posture was measured by plumb line and craniovertebral angle. Elderly balance was evaluated before and after 8 weeks of head and neck stabilization exercises with Timed Up and Go (TUG) and Functional Reach (FR) tests. The paired t-test was used to examine the changes that occurred after the intervention. Results: The results showed that head and neck stabilization exercises in the elderly significantly changed TUG test (8.3 s before the intervention, 7.8 s after the intervention; P=0.03) and FR test (23.4 cm before the intervention, 24.7 cm after the intervention; P=0.01) omitted. No significant statistical changes were observed in the amount of the craniovertebral angle after the intervention. Conclusion: Based on the study results, performing the head and neck stabilization exercises did not cause significant changes in the craniovertebral angle but improved the dynamic balance of the elderly.

Objective: Self-medication with antibiotics (SMA) is a common cause of antibiotic resistance, a major public health problem. This research aimed to identify the prevalence of SMA and explore reasons for practicing SMA among people living in Kabul, Afghanistan.Methods: A community-based cross-sectional study was conducted from May to November 2017 in 12 community pharmacies operating across Kabul, Afghanistan. Multivariable logistic regression was conducted to identify the factors associated with the use of SMA.Results: Out of 385 participants, 282 (73.2%) practiced SMA during the last year. Overall, 241 (62.6%) were 'very concerned' about the use of SMA, and 156 (40.5%) highlighted it is bad to practice SMA. The top three antibiotics used for self-medication were penicillin (ATC class: J01C), metronidazole (ATC: P01AB01), and ceftriaxone (ATC: J01DD04). Economic problems, lack of time to visit doctors, and ease of use were cited as the main reasons for practicing SMA. Furthermore, female participants were less likely to practice SMA compared to male counterparts.Conclusion: While efforts should be directed to enforce strict drug regulations system and awareness programs, priority should be given to provide accessible, affordable, and quality health care services to increase citizen's compliance to appropriate drug prescriptions.

During the past decade, accumulating evidence from the research highlights the suggested effects of bacterial communities of the human gut microbiota and their metabolites on health and disease. In this regard, microbiota-derived metabolites and their receptors, beyond the immune system, maintain metabolism homeostasis, which is essential to maintain the host's health by balancing the utilization and intake of nutrients. It has been shown that gut bacterial dysbiosis can cause pathology and altered bacterial metabolites' formation, resulting in dysregulation of the immune system and metabolism. The short-chain fatty acids (SCFAs), such as butyrate, acetate, and succinate, are produced due to the fermentation process of bacteria in the gut. It has been noted remodeling in the gut microbiota metabolites associated with the pathophysiology of several neurological disorders, such as Alzheimer's disease, multiple sclerosis, Parkinson's disease, amyotrophic lateral sclerosis, stress, anxiety, depression, autism, vascular dementia, schizophrenia, stroke, and neuromyelitis optica spectrum disorders, among others. This review will discuss the current evidence from the most significant studies dealing with some SCFAs from gut microbial metabolism with selected neurological disorders.

Following cancer, cells in a particular tissue can no longer respond to the factors involved in controlling cell survival, differentiation, proliferation, and death. In recent years, it has been indicated that alterations in the gut microbiota components, intestinal epithelium, and host immune system are associated with cancer incidence. Also, it has been demonstrated that the short-chain fatty acids (SCFAs) generated by gut microbiota are vitally crucial in cell homeostasis as they contribute to the modulation of histone deacetylases (HDACs), resulting effected cell attachment, immune cell immigration, cytokine production, chemotaxis, and the programmed cell death. Therefore, the manipulation of SCFA levels in the intestinal tract by alterations in the microbiota structure can be potentially taken into consideration for cancer treatment/prevention. In the current study, we will explain the most recent findings on the detrimental or protective roles of SFCA (particularly butyrate, propionate, and acetate) in several cancers, including bladder, colon, breast, stomach, liver, lung, pancreas, and prostate cancers.

Objective Maintaining balance is one of the most important functions of neuromuscular system in performing all simple and complex¬ sports activities. Musculoskeletal deformities especially, genu varum in the lower extremity, can negatively affect the body’s biomechanics. The aim of this study was to the compare the balance of male athletes aged 11-14 years with and without genu varum. Methods This study has a causal-comparative design. From a total of 580 amateur adolescent male athletes in basketball, handball and volleyball living in Marivan County, who had training three sessions per week, 21 with genu varum (Mean±SD of age=13.15±1.22 years; Mean±SD of height=1.68±2.32 cm; Mean±SD of weight=51.23±4.48 kg) and 21 with no genu varum (Mean±SD of age=12.95±1.17 years; Mean±SD of height=1.67±1.45 cm; Mean±SD of weight=49.49±3.48 kg) were recruited. Their genu varum deformity was assessed using a caliper. Static and dynamic balance was evaluated by Bass Stick test and Y Balance test, respectively. Data analysis was performed using independent samples t-test. Results There was no significant difference in static balance between those with and without genu varum (P=0.61), while their dynamic balance was significantly different in posteromedial (P=0.003) and posterolateral (P=0.004) directions. Conclusion Negative effect of knee deformity on balance are turned out over time. Preventive measures and appropriate exercises at an early age may reduce the negative effects of deformities on balance.

Introduction: Serum uric acid (UA) level is reported to be associated with a variety of cardiometabolic risk factors. Although various studies have reported elevated levels of UA in patients with metabolic syndrome (MetS), its clinical interpretation is still controversial and challenging. Thus, we examined the association between hyperuricemia (HUA) and UA levels with MetS, its components and number of components. Materials and Methods: This population-based cross-sectional study included 1561 older people who participated in Amirkola Health and Aging Project (AHAP) in North of Iran. MetS was defined based on the Iranian National Committee of Obesity criteria. Blood pressure, fasting blood glucose (FBG), lipid profiles, UA and anthropometric measures were determined. Results: The diagnosis of the MetS was not associated with UA levels and HUA. The results of this study showed that the only FBG is a component which increases the risk of HUA. Conclusions: Our findings from a community elderly population suggest that the UA levels and HUA were not associated with the diagnosis of the MetS by the stepwise logistic regression approach. However, in spite of various confounding factors, including metabolic and non-metabolic components in the association with MetS and UA, the whole relationship remains to be determined. A large prospective study is needed to reveal the clinical significance of UA in MetS.

In this paper, the vibration analysis of a Silicon Biological Nano-sensor (SBNS) with full coverage of Myosin as biologically adsorbent layer is investigated based on modified nonlocal Euler–Bernoulli beam model. This SBNS works based on calculating the shift of resonant frequency in the presence of Myosin layer and adsorbed viruses and bacteria. For this end, the effects of surface stresses, nonlocal parameter, and rotary inertia as well as the mass and stiffness of the adsorbent layer are taken into account, which can play a major role in changing the resonant frequency and the precision of SBNSs at nano-scale. The results illustrate that the effects of adsorbent layer, surface stresses, nonlocal parameter and rotary inertia may reduce resonant frequency of SBNS, which is significant especially at nano-scale. Finally, for the purpose of verification assessment, the numerical results were compared with the results of other studies and showed complete agreement. The present study can provide helpful insights for the design and characterization of accurate biological Nano-sensors.

Background and Aim: Time is the main determinant factor for survival chance in trauma patients. Therefore, this study was performed to determine the effect of management programs in trauma patients on time indices of pre-hospital emergency missions. Materials and Methods: In this controlled field trail, 60 pre-hospital emergency technicians were divided into two test and control groups, by means of stratified random sampling. Pre-hospital trauma management training programs which had been formulated on the basis of available national and global standards were implemented, by using a combination of training lecture and simulation methods for the test group. Research tools were demographic questionnaire and standard pre-hospital emergency care reporting form. Mean values for time indices were determined before, after, and also one month after intervention in both groups. Using SPSS 19, data were analyzed by independent t-test, Repeated Measures Analysis of Variance, and Bonferroni’s follow up test. Results: Mean scene time in the test group (one month after intervention) was significantly lower than that in the control group (p=0.05). Also, mean and standard deviation of scene time in the test group decreased from 17.6±5.5 minutes (before intervention) to 12±3.8 minutes (one month after intervention), which showed a significant reduction (p˂0.001). Conclusion: According to the results, performance of pre-hospital trauma management training programs can lead to reduction of scene time in pre-hospital emergency missions. Therefore, considering the role of reduced scene time in the prognosis of trauma patients, integration of the periodic training of the trauma management programs into pre-hospital emergency training programs seems necessary.

Purpose Nontuberculous mycobacteria (NTM) infection is an increasing problem worldwide whose clinical significance is still largely unknown. The aim of this study was to investigate the epidemiology of NTM infection from respiratory samples and to determine their clinical significance. Patients and methods This cross-sectional study was performed on 7,825 clinical samples from December 2015 to December 2017. Detection was conducted using phenotypic and genotypic (hsp65 PCR-RFLP, rpoB, and 16S rRNA genes sequencing) methods. All clinical information including symptoms and radiological findings was extracted from patients' records. Results A total of 478 were confirmed to have respiratory samples which were culture positive for mycobacteria, with the prevalence of NTM infection obtained as 53 (11.1%). Overall, Mycobacterium (M.) fortuitum was the most frequent NTM isolate, followed by M. simiae, M. kansasii, M. gordonae, and M. conceptionense. There was a relationship between NTM isolates and gender (P=0.039), symptoms (P=0.048), and radiographic findings (P=0.013). Bronchiectasis, infiltration, and cavitary lesion were the most frequent radiological findings in M. fortuitum, M. simiae, and M. kansasii, respectively, with cough being the most frequent symptom. Conclusion We reported five different NTM isolates in respiratory samples with a high frequency of M. fortuitum. NTM infections may play an important role in causing pulmonary disease and in tuberculosis management in endemic settings. Nevertheless, more studies are required to further examine the clinical significance of NTM isolates.

Objective: The aim of this study is to investigate effect of maternal separation stress on the ovarian function in adult female mice. Methods: In this study, maternal separation in pups was performed during post-natal days (PND) 2 to 14. The histological alterations in ovarian tissue, ROS production (using DCFH-DA assay), gene expression of NLRP3, ASC, caspase-1, TLR4, BAX, BCL-2 and TNFα (using RT-PCR), protein levels of ATP, GPx, IL-1β and IL-18 (using ELISA). Also, protein expression of caspase-3 and NLRP3 (using immunocytochemistry) were evaluated. Results: Results showed that maternal separation decreased percentage of primordial follicles while increased percentage of secondary and graafian follicles. In addition, maternal separation increased ROS production and decreased ATP and GPx concentrations. Furthermore, maternal separation significantly affected expression of cytokines and genes involved in inflammation and apoptosis including NLRP3, ASC, caspase-1, TLR4, TNFα, IL-1β, IL-18 BAX and BCL2. Findings also showed that stress-induced maternal separation significantly increased percentage of caspase-3 and NLRP3 positive cells. We concluded that maternal separation stress has harmful effects on ovarian tissue. Conclusion: It seems that these harmful effects are probably occur through increase of ROS production and impact on mitochondrial function, inflammatory process and apoptosis pathways.

Background: Physical activity is a behavioral strategy that increases general (public) health, including the mental performance of individuals. The goal of this study was to investigate the effect of group physical games on cognitive performance (memory, attention) of old people in adult day-care centers. Methods: In this quasi-experimental study, 50 elderly people (aged >60 years) were selected from two adult day-care centers using available sampling and divided into two groups: control and intervention. As approval was received from the Babol Hamrah Salamat adult day-care center to modify the design of the center's yard, this center was selected to conduct an intervention program. The intervention group received a physical activity program twice a week for 6 weeks. Questionnaires that were used for collecting data included demographic questions, a standard questionnaire for daily activities of living, and a short-term test, the Abbreviated Mental Test Score. Cognitive function was assessed with the Wechsler Memory Scale (WMS) (Form A), before and after the intervention. Statistical analysis of normal variables was performed using independent and paired t-tests and in non-standard cases with Mann-Whitney and Wilcoxon non-parametric tests at a significance level of P

Objectives The involvement of factors such as serum lipids and lipoproteins concentration has been reported as a potential risk factor for cognitive impairment. This study aimed to investigate the effect of underlying factors and serum lipid levels on cognitive impairment in the elderly. Methods & Materials This cross-sectional study was conducted on 1519 elderly in Amirkola City by the census method, from September 2016 to March 2017 (6 months). The data collection tools were a background information form of older adults and the mini-mental state exam. The obtained data were analyzed in SPSS version 23 using descriptive statistics and inferential statistics such as the Kolmogorov-Smirnov test, the Chi-squared test, analysis of variance (1-way ANOVA) and Tukey’s post hoc test. Results According to the results, 9% (13 elderly) of the study population had severe cognitive impairment. The results of the Chi-square test did not show a significant relationship between gender and cognitive impairment (P>0.05). The significant differences were found between age, blood pressure, total cholesterol, and low-density lipoproteins variables with the categorized groups of cognitive impairments of the elderly (P≤0.05). Conclusion Screening for cognitive impairments is one of the recommendations of this study. Early diagnosis and treatment of this disease, especially in high-risk groups such as women and elderly with hypertension and disrupted serum lipid profile can play an important role in controlling the disease and reducing the care burden.

Legionella pneumophila causes a severe form of pneumonia known as Legionnaires' disease especially in patients with impaired cellular immune response. In order to prevent the disease, immunogenicity and the level of the induction of protective immunity from the recombinant peptidoglycan-associated lipoprotein (rPAL) against Legionella pneumophila in BALB/c mice was examined. Mice immunized with (rPAL) rapidly increased an antibody response in serum and also displayed a strong activation of both innate and adaptive cell-mediated immunity as determined by antigen-specific splenocyte proliferation, an early production of pro-inflammatory cytokines in the serum and in the splenocyte cultures. Infection with a primary sublethal does of Legionella pneumophila serogroup 1, strain paris, caused resistance to a lethal challenge infection in the animals with 100% survival rate. However, mice treated with rPAL survived with 60% rate in 10 days after a lethal i.v challenge with L. pneumophila. All of the control animals receiving PBS died within 24 h. The present study indicates that recombinant protein PAL of Legionella pneumophila is strongly immunogenic and capable to elicit early innate and adaptive immune responses and lasting immunity against a lethal dose of Legionella pneumophila challenge. Antigenic characterization and immune protection of recombinant protein PAL would be of considerable value in comprehension the immune-pathogenesis of the disease and in development possible vaccine against the Legionella.

Background. Atherosclerosis is known as one of the chronic diseases with high prevalence in the human species. Many studies have elucidated the relationship between this disease and chronic periodontitis caused by Porphyromonas gingivalis (P.g). The aim of this study was to investigate the prevalence of P.g fimbriae A (fimA) genotypes II and IV in patients with periodontitis and atherosclerosis. Methods. This cross-sectional study investigated the frequency of P.g II and IV genotypes in the subgingival plaque specimens of 42 subjects in three experimental groups: periodontitis (A), atherosclerosis (B), periodontitis + atherosclerosis (C) and aortic wall specimens obtained from 30 patients (groups B and C) by the PCR technique. Results. P.g bacterium was seen in 46.6% of patients with chronic periodontitis. The same bacterium was not found in aortic wall specimens of patients with chronic periodontitis (group C) and there was only one P.g-positive aortic wall specimen (7.7%) among the patients with healthy periodontium (group B). Genotypes II and IV were not observed in any specimen. Conclusion. The results of statistical analysis showed no significant correlation between the prevalence of P.g and genotypes II and IV in the subgingival plaques and the incidence and severity of atherosclerosis.

Exosomes are a nano-vesicle surrounded by a bilipid layer that can release from almost all cells and could be detected in tissues and biological liquids. These vesicles contain lipids, proteins, and nucleic acids (including DNA, mRNA, and miRNA) inside and on the exosomes' surface constitute their content. Exosomes can transfer their cargo into the recipient cell, which can modify recipient cells' biological activities. Recently it has been deciphering that the miRNA pattern of exosomes reveals the cellular pathophysiological situation and modifies various biological processes. Increasing data regarding exosomes highlights that the exosomes and their cargo, especially miRNAs, are implicated in the pathophysiology of various disorders, such as autoimmune disease. The current evidence on the deciphering of mechanisms in which exosomal miRNAs contributed to autoimmunity was indicated that exosomal miRNA might hold information that can reprogram the function of many of the immune cells involved in autoimmune diseases' pathogenesis. In the present study, we summarized the pathogenic role of exosomal miRNAs in several autoimmune diseases, including myasthenia gravis (MG), psoriasis, inflammatory bowel disease (IBD), type 1 diabetes (T1D), multiple sclerosis (MS), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjogren's Syndrome (SS), systemic sclerosis (SSc), vitiligo, and autoimmune thyroid diseases (AITD). Moreover, in this work, we present evidence of the potential role of exosomal miRNAs as therapeutic and diagnostic agents in autoimmune diseases.

AIM In the present study we aimed to investigate the effects of nano-curcumin supplementation on gene expression and serum levels of IL-4 and TGF-β in migraine patients. METHODS Forty participants with episodic migraine were randomly allocated to receive 80 mg nano-curcumin (n = 20) or placebo (n = 20) in a randomized double-blind clinical trial for two months. At the beginning and the end of the study, the interictal serum levels and gene expression of IL-4 and TGF-β in peripheral blood mononuclear cells (PBMCs) isolated from migraine patients were measured, using ELISA and real-time PCR methods, respectively. RESULTS Intra-group assays showed a significant rise in the gene expression of both IL-4 and TGF-β (p

BackgroundHypertension, the most common comorbidity among coronavirus disease 2019 (COVID-19) patients, is accompanied by worse clinical outcomes, but there is lack of evidence about prognostic factors among COVID-19 patients with hypertension. We have come up with some prognostic factors to predict the severity of COVID-19 among hypertensive patients. In addition, epidemiologic, clinical and laboratory differences among COVID-19 patients with and without underlying hypertension were evaluated.MethodsMedical profiles of 598 COVID-19 cases were analyzed. Patients were divided into two comparative groups according to their positive or negative history of hypertension. Then, epidemiologic, clinical, laboratory and radiological features and also clinical outcomes were compared.Results176 (29.4%) patients had underlying hypertension. Diabetes was significantly higher in hypertensive group [72 (40.9%) vs 76 (18%)] (P-value: 0.001). Cardiovascular and renal disorders were significantly higher in hypertensive patients. (P-value: 0.001 and 0.013 respectively). In COVID-19 patients with hypertension, severe/critical types were significantly higher. [42(23.8%) vs. 41(9.7%)], (P-value: 0.012). In the logistic regression model, Body mass index > 25 (ORAdj: 1.8, 95% CI: 1.2 to 2.42;P-value: 0.027), age over 60 (ORAdj: 1.26, 95% CI: 1.08 to 1.42;P-value: 0.021), increased hospitalization period (ORAdj: 2.1, 95% CI: 1.24 to 2.97;P-value: 0.013), type 2 diabetes (ORAdj: 2.22, 95% CI: 1.15 to 3.31; P-value: 0.001) and chronic kidney disease (ORAdj: 1.83, 95% CI: 1.19 to 2.21; P-value: 0.013) were related with progression of COVID-19.ConclusionHypertensive patients with Age > 60-year-old, BMI > 25 Kg/m2, CVD, diabetes and chronic kidney disease are associated with poor outcomes in those with COVID-19 infection.

Highlights • The pandemic of COVID-19 has imposed significant public health problems globally. • MiRNAs play a significant role in the control of various cellular processes against viral infections. • The pattern of expression of miRNA may be involved in the severity of COVID-19. • Host miRNAs may have both functions, antiviral, or promote infection. • MiRNAs can act as a means of preventing, diagnosing and curing viral infections., The novel coronavirus disease 2019 (COVID-19) pandemic has imposed significant public health problems for the human populations worldwide after the 1918 influenza A virus (IVA) (H1N1) pandemic. Although numerous efforts have been made to unravel the mechanisms underlying the coronavirus, a notable gap remains in our perception of the COVID-19 pathogenesis. The innate and adaptive immune systems have a pivotal role in the fate of viral infections, such as COVID-19 pandemic. MicroRNAs (miRNAs) are known as short noncoding RNA molecules and appear as indispensable governors of almost any cellular means. Several lines of evidence demonstrate that miRNAs participate in essential mechanisms of cell biology, regulation of the immune system, and the onset and progression of numerous types of disorders. The immune responses to viral respiratory infections (VRIs), including influenza virus (IV), respiratory syncytial virus (RSV), and rhinovirus (RV), are correlated with the ectopic expression of miRNAs. Alterations of the miRNA expression in epithelial cells may contribute to the pathogenesis of chronic and acute airway infections. Hence, analyzing the role of these types of nucleotides in antiviral immune responses and the characterization of miRNA target genes might contribute to understanding the mechanisms of the interplay between the host and viruses, and in the future, potentially result in discovering therapeutic strategies for the prevention and treatment of acute COVID-19 infection. In this article, we present a general review of current studies concerning the function of miRNAs in different VRIs, particularly in coronavirus infection, and address all available therapeutic prospects to mitigate the burden of viral infections.

Background: The global incidence rate of frailty syndrome among older adults aged 60 and over has been estimated to be 43.4 cases per 1000 persons/years. Objectives: This study aimed to determine the prevalence of pre-frailty and frailty syndromes in community-dwelling older adults and assess the correlated sociodemographic factors. Methods: All elderly people recruited in the second phase of the Amirkola Health and Ageing Cohort Project, including 2135 older adults aged ≥60 years living in Amirkola, North of Iran, were invited to participate in this study using the census method. The standard "FRAIL" scale was used to assess the frailty syndrome. The individuals who obtained a score of three or more and one or two were classified as frail and pre-frail cases, respectively. Results: Totally, 2010 older adults with a mean age of 70.41±7.65 years were included in this study. Out of them, 672 (33.4%; 95% CI: 31.37-35.50%) cases met the criteria for frailty syndrome, and 874 (43.5%) individuals were regarded as pre-frail. The prevalence of frailty was significantly higher in females (50.8%; 95% CI: 47.58-54.05%), compared to males (18.7%; 95% CI: 16.41-21.05%). Multivariate logistic regression analysis revealed that age ≥85 (OR=7.27; 95% CI: 4.12-24.46) and female gender (OR=2.67; 95% CI: 2.30-9.95) had the highest effect on frailty in older adults. Conclusion: One out of every three elderly people (aged ≥60) in Amirkola, North of Iran, had frailty syndrome. Older age, female gender, lower education level, low level of satisfaction with income, marital status (single), living alone, and unemployment increased the risk of frailty in older adults.

Cutaneous leishmaniasis (CL) is mainly caused by L. major and L. tropica in Old World and might be represented as typical skin lesion(s) or sometimes as a spectrum of atypical manifestations. We applied multilocus sequence typing (MLST) to explore genetic variations of Leishmania strains isolated from atypical vs. typical CL patients from Iran. A PCR-sequencing was performed for seven housekeeping genes (g6pd, mpi, asat, icd, 6pgd, fh, and trys) and genetic diversity indices and phylogenetic relationships were analyzed. A total of 41 isolates of L. major (28/41) and L. tropica (13/41) from 21 (51.2%) atypical CL and 20 (48.8%) typical CL cases were included. A set of additional sequences of 41 strains of 17 species of Leishmania were retrieved from databases. Different SNP variations were detected and the highest rate of heterozygous sites was found in g6pd and 6pgd genes (6 sites) for L. tropica and in asat and 6pgd genes (7 sites) for L. major strains. All strains were clustered into 58 unique sequence types (STs) including 17 STs related to 41 strains of Leishmania of this study. Concatenated tree clustered all strains in 6 main clades (A to F) including L. major (clade D) and L. tropica (clade B) strains. Two strains of L. major (codes 28 and 42) with highest nucleotide variations were more close to L. tropica and were grouped in Clade B. All of the STs were related in clonal complexes by using eBURST with the prediction of founder genotypes. A high rate of genetic variations and heterozygocity was evident in L. tropica and L. major strains; nevertheless, there was no significant difference in the diversity of Leishmania strains between typical CL and atypical CL groups. This study represents the first successful application of MLST approach to L. tropica and L. major strains in Iran.

BackgroundEarly detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. This study evaluated a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment.Methods99 participants diagnosed with Dementia, Mild Cognitive Impairment (MCI), or Normal Cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group.ResultsBrainCheck battery performance showed significant differences between the NC, MCI, and Dementia groups, achieving ≥88% sensitivity/specificity for separating NC from Dementia, and ≥77% sensitivity/specificity in separating the MCI group from NC/Dementia groups. Three-group classification found true positive rates ≥80% for the NC and Dementia groups and ≥64% for the MCI group.ConclusionsBrainCheck was able to distinguish between diagnoses of Dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.

COVID-19 is an acute respiratory infection accompanied by pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has affected millions of people globally. To date, there are no highly efficient therapies for this infection. Probiotic bacteria can interact with the gut microbiome to strengthen the immune system, enhance immune responses, and induce appropriate immune signaling pathways. Several probiotics have been confirmed to reduce the duration of bacterial or viral infections. Immune fitness may be one of the approaches by which protection against viral infections can be reinforced. In general, prevention is more efficient than therapy in fighting viral infections. Thus, probiotics have emerged as suitable candidates for controlling these infections. During the COVID-19 pandemic, any approach with the capacity to induce mucosal and systemic reactions could potentially be useful. Here, we summarize findings regarding the effectiveness of various probiotics for preventing virus-induced respiratory infectious diseases, especially those that could be employed for COVID-19 patients. However, the benefits of probiotics are strain-specific, and it is necessary to identify the bacterial strains that are scientifically established to be beneficial.

Background Parkinson's disease is a progressive neurodegenerative disease and the second most common neurological disease in the world, which usually affects people mainly in later years of life. Cognitive impairments and depressive symptoms are important symptoms in these patients that are associated with a poor prognosis. The study will focus on the original data regarding the cognitive impairments and depressive symptoms in patients with Parkinson's disease and control group. Methods In a case-control study, a total of 100 Parkinson's patients who were hospitalized in Rouhani Hospital and 200 non-Parkinson's people (control group) from Amirkola Health and aging project (AHAP) Marras et al., Babol, Iran were enrolled between September 2019 to February 2020. Data were collected by simple random sampling. Data were collected using a four-part questionnaire, including demographic characteristics, Unified Parkinson Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging Scale (MHYSS), Mini-M ental State Examination (MMSE) and Geriatric Depression Scale (GDS). P-value less than 0.05 was considered as significant Results A total of 300 persons were enrolled in the study. The mean age of Parkinson's patients and non-Parkinson's people was 70.34 ± 7.76 and 70.87 ± 7.59 years, respectively. The mean MMSE score in Parkinson's and non-Parkinson's people was 24.80 ± 4.53 and 25.40 ± 3.1, respectively (p = 0.182). The mean GDS score in Parkinson's and non-Parkinson's people was 7.06 ± 4.06 and 4.31 ± 3.47, respectively (p = 0.001). There was a statistically significant relationship between depressive symptoms and cognitive impairments with disease severity (p = 0.022 and p = 0.012, respectively). In addition, variables, such as age and the education level were associated with cognitive impairments (p = 0.001 and p = 0.021, respectively), but these variables were not significantly associated with depressive symptoms (p = 0.843 and p = 0.411, respectively). There was a significant relationship between depressive symptoms and cognitive impairment in Parkinson's patients and the control group (p = 0.001 and p = 0.003, respectively). Conclusions Cognitive impairments and depressive symptoms were significantly associated with an increase in the severity of Parkinson's disease, and also, depressive symptoms in Parkinson's patients was associated with an increase in cognitive impairments.