reza yazdani

The present study aims to examine and explain the role of rail transport in Iran’s economic development from the customers' perspective. This research was conducted using a survey method, employing a questionnaire distributed among 384 rail transport customers. The validity of the questionnaire was confirmed by five experts, and its reliability was assessed through Cronbach’s alpha coefficient, with values exceeding 0.7 for all variables, indicating satisfactory reliability of the measurement tool. Data analysis was performed using SPSS software. The results revealed that rail transport has a significant impact on attracting global business opportunities, economic competitiveness, traffic congestion reduction, and road maintenance. Additionally, this study examined the relationship between rail infrastructure development and its impact on economic productivity. The findings indicated that increased investment in the rail transport sector can enhance transportation efficiency and improve Iran's trade conditions. One of the most critical outcomes of this study was identifying the challenges hindering the expansion of the rail system, including high development costs and a lack of attractiveness for private investors. This research can assist policymakers in developing appropriate strategies to improve rail transport. The findings align with international studies in this field, emphasizing the importance of this sector in sustainable economic development. It is recommended that precise planning be undertaken to expand rail networks and enhance service quality in this domain.

At present, a national consensus or guideline for diagnosing and managing patients suspected of having predominantly antibody deficiencies (PADs) is lacking. This consensus is written based on a combination of scientific literature and comments from the expert panel of Iranian immunologists. A group of clinical immunologists reviewed the current consensus, presented their comments at a meeting titled 'First Meeting on the Diagnosis of Inborn Errors of Immunity (IEI) by IEI Experts,' and agreed on this consensus. This consensus guideline provides recommendations on the diagnosis, antimicrobial prophylaxis, management of clinical manifestations, and immunoglobulin replacement therapy (IgRT) for patients with PAD.

Disadvantaged subjects are considered a high-risk group due to limited access, insufficient awareness regarding the importance of oral health, and lack of preventive behavior. This study explores oral health literacy (OHL), oral health behaviors (OHB), and factors associated with OHL among women living in Zahedan's slum areas in Iran.

In 2020, a cross-sectional study was carried out on 216 disadvantaged women in the slums of Zahedan City in Iran. The women's OHL and OHB data were collected using the Persian version of the previously validated Oral Health Literacy-Adult Questionnaire. Statistical analysis, including descriptive and analytical statistics, such as multi-variable linear regression analysis, was conducted using the STATA software version 14.2.

All 216 female subjects residing in the slum areas of Zahedan City completed the questionnaire (response rate: 100%). The mean age of participants was 26.7(±5.03) years old. The respondents' mean score of OHL was 7.6 (±2.47) out of 17. 18.98% reported brushing their teeth twice or more daily, 83.3% used fluoride toothpaste, 37.96% had visited a dentist within the past year, 50.93% consumed sugary snacks less than twice per day, and 87.96% did not smoke. In the regression analysis, there was a significant positive relationship between OHL with age (P<0.001), occupation (P=0.03), and educational level (P<0.001).

The level of oral health literacy among women in the slum area was insufficient. The significant positive associations between OHL and factors such as age, occupation, and education level suggest that targeted educational interventions and community-based programs may be needed to improve oral health knowledge and behaviors in this population.

 Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department.

 This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files.

 The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028).

 The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.

This study evaluated the effect of a flipped oral health educational program for primary healthcare providers (PHCPs) on their knowledge, attitude, and practice.

This field trial was conducted on PHCPs (N=118; 61 cases and 57 controls) in District Health Centers (DHCs) of Tehran, Iran in 2012. The participants filled out a self-report questionnaire with questions on knowledge (N=34), attitude (N=8), and oral health practice (N=14). The intervention included an educational booklet delivered to the staff followed by a brief educational session using the flipped approach and a reminder pamphlet after 1 month. After 4 months, the questionnaire was completed again by the participants. Statistical analysis included paired sample t-test, ANCOVA, and linear and logistic regression.

Most participants were females (N=114), and the mean age was 37±8 years. The scores of the three domains of knowledge and also the total knowledge score, the attitude score, and the practice score significantly improved in the intervention group compared to the control group (P<0.001). Knowledge about the oral health of children (P=0.001) and the total knowledge score (P<0.05) significantly increased in the control group, but the increase in other domains was not statistically significant (P>0.05).

The oral health knowledge of PHCPs was insufficient, and their practice and attitude were not desirable. The oral health educational program with the flipped approach had a positive impact on the PHCPs’ knowledge, attitude and practice, and may be utilized in the academic curriculum or continuing medical education (CME) courses.

T and B lymphocytes development and function are highly dependent on Recombination Activating Genes (RAG) 1 and 2. RAG mutations result in different degrees of T and B cell impaired function, broad clinical manifestations, and immunological manifestations. Pathogenic mutations cause severe combined immunodeficiency (SCID) phenotype, while hypomorphic mutations are responsible for leaky or partial SCID.

Here, we described a 4-year-old girl who had a persistent diarrhea, recurrent infection, and vomiting. Although physicians were suspicious about autoimmune enteropathy, her molecular report showed a homozygous and novel RAG2 mutation in its core domain. The number of CD4 T cells and IgA level were lower than normal ranges. Lack of IgA brought about different GI complications. Our patient died finally because of liver and gallbladder failure.

Oral health literacy (OHL) is an interplay of cultural, social and individual factors and plays an effective role in public health promotion. This study aimed to assess OHL and its socioeconomic and demographic determinants among young couples.

This analytical cross-sectional study was conducted on 828 adults between 15 to 35 years in 2018 in Zanjan city. Data regarding their OHL were collected by using a 17-item Oral Health Literacy-Adult Questionnaire (OHL-AQ) that was filled out by a combination of self-report and interview. OHL was categorized as adequate, marginal, and inadequate. The effects of age and gender as demographic variables, and floor area per person as a proxy of financial status on OHL were also assessed. Data were analyzed using the linear and multinomial logistic regression models.

The mean OHL score was 7.86±3.83 out of 17 in equal number of males and females. Only 21% of the couples had adequate OHL. The socioeconomic, but not demographic variables had significant correlations with the qualitative and quantitative variables of OHL even after controlling for the effect of confounders. A correlation was particularly found between inadequate OHL and years of education [odds ratio:6.00; 95% CI: 3.86-9.28); P<0.001].

Socioeconomic factors had independent correlations with inadequate OHL. Participants with higher levels of education, those living in urban areas, and individuals with better financial status had higher levels of OHL and lower odds of inadequate OHL.

In the last decade, Information and Communication Technology (ICT) was used as the most effective tool to help businesses gain a competitive advantage by attracting customers. Thus, ICT has significantly contributed to the growth of e-commerce. Internet access allows e-commerce to spread globally and cheaply. However, many organizations did not realize the potential value created by e-commerce. Since the provision of information and branding at the destination necessarily involves the focused attention of all tourism companies in the destination, e-commerce can lead to the development of a new distribution channel in a virtual network and connects the producer with the customer. To this end, the present study analyzed the factors affecting brand strengthening drivers in e-commerce in the Iranian tourism industry. Brand strengthening drivers were ranked using Shannon’s entropy method. The results indicated that advertising and brand communication are the most effective brand strengthening drivers.

The increase in demand for emergency services causes overcrowding in emergency departments. Length of stay in emergency departments also influences overcrowding in emergency departments and is a key factor for monitoring the performance in emergency departments. This study investigated the factors affecting length of stay in patients referred to emergency department in Bandar Abbas, Iran.

This retrospective cross-sectional study was conducted from December 2018 and February 2019 by investigating 234 eligible patients referred to Emergency Department of Shahid Mohammadi. Demographic characteristics were also recorded, which included gender, age, type of disease, triage level, the time for entry to emergency specialist visit, specialist visit to order time, entry to imaging/lab assay, entry to other specialist consultants, and time for entry to final decision.

The results did not indicate any significant difference in both genders and all age groups (P>0.05), but entry time to lab/imaging assays was significantly lower in patients under 40 years old (P=0.001). Moreover, specialist visit to order time (P=0.001), entry to lab/imaging assays (P=0.003), and entry to final decision time (P=0.013) were significantly shorter in the patients with cardiac diseases. Furthermore, entry to specialist visit time (P=0.001), entry to lab/imaging assays time (P=0.0212), and entry to final decision time (P=0.004) were significantly lower in the patients with lower levels of triage.

Triage levels are contributing factors for lengths of stay in emergency department, and these factors can be used for decreasing emergency department lengths of stay.

The most effective way to maintain and improve oral health is tooth brushing to physically remove dental plaque. In this regard, this study was conducted to compare the efficiency of the usual method of each person in comparison with different methods of brushing to remove dental plaque.

This study was conducted in 2020, as a randomized and open clinical trial with 72 non-dental male and female students of Tehran University of Medical Sciences. In this study, the usual method of tooth brushing with Modified Bass and Scrub Horizontal methods after training was evaluated in two random groups with plaque and gingival indices. Plaque index as a percentage and gingival index as a number (numbers between 0-1 mild inflammation, 1.1-2 moderate inflammation, 2-3 severe inflammation) were reported. The results were analyzed using SPSS25 software and paired t-test and variance equality test.

The efficiency of the usual tooth brushing method in comparison with the two Modified Bass and Scrub Horizontal methods using two indicators of dental plaque and gingival indices was not statistically significant (P>0.05). Each method alone after tooth brushing significantly removed dental plaque (P<0.05).

The results of this study showed that the efficiency of the usual method of tooth brushing compared to trained methods in removing dental plaque and reducing gingivitis in short-term evaluation was not statistically significant.

Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents. In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded. In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001). Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.

The aim of the present study was to develop and evaluate the psychometric properties of an instrument in Persian to assess the mothers’ knowledge, and perception about oral health of school children.

A sequential exploratory mixed method design consisting of qualitative and quantitative phases was performed. We developed the questionnaire by inductive-deductive method, through a synthesis of literature review and a qualitative study with semi-structured interviews and focus group discussions. Face and content validity of the items were assessed by consulting a panel of 11 experts. In the quantitative phase, an exploratory factor analysis was performed using data from a cross-sectional study with a sample of 303 mothers. Reliability analysis with test-retest approach and Cronbach’s alpha coefficient and intra-class correlation coefficient (ICC) was done.

Pre-final version of the scale consisted of 120 items extracted from the qualitative study and literature review. After content and face validity, 92 items were chosen with the greatest agreement between experts, with a content validity index (CVI) >0.8 and content validity ratio (CVR) of 0.59. The final questionnaire covered 62 items. The overall Cronbach’s alpha was 0.94 and it ranged from 0.87 to 0.97 for the subscales. The ICC ranged from 0.91 to 0.98 (Cronbach's alpha ≥0.70).

The present study introduced a valid and reliable questionnaire for assessment of the mothers’ perception regarding school children’s oral health. It can be used as a standardized measure for public health surveillance and evaluation of oral health promotion programs.

This study aimed to evaluate the effect of an educational intervention on oral health-related knowledge, attitude, and practice of medical students.

This study was performed on the fifth-year medical students attending an elective oral health course at the Faculty of Dentistry of Tehran University (intervention group) and 25 other students attending another elective course (control group) in 2018. A 2-week internship program including 6 sessions of a workshop program plus 2 days of school field and 2 days of attending dental departments was designed for the intervention group. Before and after the intervention, students completed a questionnaire and their simplified debris index was calculated. Statistical analysis was performed using SPSS version 24 by pairedsample t-test and general linear regression.

The mean age of the participants was 24.84±1.31 years in the intervention group and 23.64±1.28 years in the control group. There were 14 (56%) males in the intervention group and 16 (64%) males in the control group. At baseline, the mean knowledge, attitude and practice scores of the control and intervention groups were 26.28, 14.20 and 10.88, and 27.84, 15.80, and 9.36, respectively. After the intervention, the knowledge, attitude, debris index and willingness to adhere to oral health measures significantly improved (P<0.05).

Oral health-related knowledge, attitude and practice of medical students were not desirable at baseline. The present study showed that even a shortterm intervention in this field was effective to improve the oral health concepts in this group.

Common variable immunodeficiency (CVID) is the most prevalent form of symptomatic primary humoral immunodeficiencies characterized by failure in the final differentiation of B lymphocytes. The majority of CVID cases have no identified genetic defect, and epigenetic alteration could be involved in the pathogenesis of CVID. Hence, we aimed to evaluate the expression of hsa-miR-125b-5p -and, B lymphocyte-induced maturation protein-1(BLIMP-1) and interferon regulatory protein-4 (IRF-4) in a group of CVID patients with no definitive genetic diagnosis in comparison with healthy individuals. Ten CVID patients (all known genes excluded) and 10 age and sex-matched healthy controls participated in the study. B lymphocytes were isolated and expression of miR-125b-5p, IRF4, and BLIMP1 were evaluated by real-time polymerase chain reaction (RT-PCR). Moreover, B cell subsets were analyzed by flow cytometry. The results showed that the relative expression of miR-125b-5p in CVID patients was increased while it was decreased for the BLIMP1 and IRF4 transcription factors compared with the healthy controls. Although a reduction was observed in switched and non-switched memory B cells among all high-miR patients, these subsets were decreased in patients with normal miR expression (71.0% and 85.0%, respectively). Our results suggest that overexpression of miR-125b-5p affects the terminal differentiation of B cells in a selected group of CVID patients by downregulating the BLIMP-1 gene and more intensively for the IRF4 gene expressions.

Although the majority of monogenic defects underlying primary immunodeficiency are microlesions, large lesions like large deletions are rare and constitute less than 10% of these patients. The immunoglobulin heavy chain (IGH) locus is one of the common regions for such genetic alterations. This study describes a rare case of autosomal recessive agammaglobulinemia with a homozygous large deletion in chromosome 14q32.33 (106067756-106237742) immunoglobulin heavy chain clusters with an unusual and severe skin infection and disseminated intravascular coagulopathy.

This study aimed to determine the self-declarative performance of general dentists in prescription of analgesics and antibiotics for patients requiring root canal treatment (RCT).

In this cross-sectional study, 400 general dentists participating in the 55th International Annual Scientific Congress of the Iranian Dental Association (2015) were randomly selected, and requested to complete a questionnaire about their performance regarding prescribing analgesics and antibiotics for patients requiring RCT. The frequency and percentage of answers to each question were calculated and reported.

The most commonly prescribed analgesics included ibuprofen (100.0%), Gelofen (100.0%), Novafen (68.5%) and acetaminophen (24.8%). After RCT, dentists prescribed ibuprofen (100.0%), Gelofen (98.3%), dexamethasone (35.3%), Novafen (27.3%) and acetaminophen/codeine (15.8%) in decreasing order of frequency. Antibiotic prescription was minimum (48.5%) for cases with painful (moderate or severe) irreversible pulpitis (vital tooth) before the treatment and maximum for cases of pulp necrosis with acute apical periodontitis, edema, and preoperative symptoms (moderate or severe) (97.3%). For non-allergic patients, the most frequently prescribed antibiotics were amoxicillin 500 mg (93.3%), cefixime 400 mg (81.3%), amoxicillin/metronidazole 250 mg (71.8%), co-amoxiclav 265 mg (36.3%) and injectable penicillin (0.5%). For allergic patients, dentists prescribed clindamycin 300 mg (84.0%), cephalexin 500 mg (15.8%), azithromycin 500 mg (13.5%), and erythromycin 500 mg (10.8%). Sex and graduation date had no significant effect on the results (P>0.05).

Antibiotic prescription is excessive by general dentists, and their performance regarding the proper and logical prescription of antibiotics in RCT should be improved.

Dental caries, as a multi-factorial problem, is prevalent among children. The aim of this review was to assess the association between dietary free sugars (DFS) consumption and dental caries in 6- to 12-year-old children in the recent longitudinal evidence.

In this systematic review, data base search was performed in PubMed, Embase, ISI Web of Science and Scopus using the keywords “diet”, “dental caries” and “school children”. We considered the articles published in English from 2004 to 2019. After duplicate removal, title, abstract, and full text of all included papers were assessed by two independent reviewers. The quality of included papers was assessed using the Newcastle-Ottawa scale.

From 2122 papers, ten longitudinal studies were included. In the included studies, the consumption of 100% juice (daily), candy (more than once a week), and soft drink and sweet drinks (at bedtime) were highly associated with caries in children. In few studies, daily consumption of water and dairy products was reported to be protective. However, some studies reported non-significant association between consumption of different sugary items and dental caries. The quality of included studies was moderate. Heterogeneity was observed in the measurement of caries outcome, and data collection tool for diet assessment, and statistical measure, which impeded the meta-analysis of data.

The methodology and results in the longitudinal studies on the association of dietary free sugar consumption and dental caries in schoolchildren were heterogeneous, which urge the need for further standard research protocols in this area.

Pregnancy is a period with hormonal and psychological changes affecting women’s oral health. The aim of present review study was to evaluate, elaborate and categorize factors affecting oral health status of pregnant women.

A literature search with the following keywords: pregnancy, “pregnant women”, “pregnant mothers” and “expectant mothers” , AND dentistry, “dental health” and “oral health” in PubMed and Scopus was performed from 2009 to 2019. Search results included 1435 articles which 467 duplicate studies were excluded. Finally, 30 articles were included in the study. Oral health outcomes were categorized and significant relationships with determinants and risk factors were reported.

Most studies (70%) were performed cross-sectionally. Among the studied outcomes, dental visit, periodontal disease and dental caries were the most common. The most studied independent variables were socioeconomic factors and demographic factors, followed by behavioral and enabling factors. The lowest frequency was related to the systemic factors. Mothers’ education and age were examined more than other variables and in about 40% of studies had significant association with outcomes. Dental counseling was assessed in only 3 studies and in all three studies, the relationship with outcome was significant.

Socioeconomic, demographic and enabling factors could affect the oral health of pregnant women.

Spinal cord injury is known as a kind of injury that causes inability. The investigation of the epidemiology of spinal cord injury and time in different regions might help to collect information for preventative measures of work. This study was conducted to investigate the epidemiology and radiologic findings of patients with traumatic spine injures among patients subjected to Emergency Department of Shahid Mohammadi Hospital of Hormozgan University of Medical Sciences. A retrospective descriptive-analytic method was adopted with an analysis of all the patients who were admitted by the diagnosis of traumatic spine injury in Shahid Mohammadi hospital. They all underwent a radiologic study. After receiving permission from the ethics committee, we extracted the data from patients’ files and carried out the analyses. Mean of age for subjects was 40.2 and 148 patients (71.50%) were men and 59 patients (28.50%) were women. The most trauma was associated with road accidents (n=124, 59.9%) and 83 cases (40.10%) were related to falling from height. Ten patients (4.80%) were dead due to trauma and 197 patients (95.20%) survived. Compress fracture (n=88, 42.50%), burst fracture (n=64, 32.40%), fracture dislocation (n=57, 27.50%) and transverse process fracture (n=43, 23.80%) accounted for all the cases. The most fracture was associated with L1 vertebrae (n=53, 15.9%), T12 (n=43, 13.40%), L2 (n=36, 11.20%) and C5 (n=16, 5%). The results for fracture in main parts showed that highest fractures were observed in cervical (n=69, 21.63%), thoracic (n=98, 30.72%) and lumbosacral (n=152, 47.64%). Our results showed that the most common causes of spinal injury in Bandar Abbas are accidents that must be reduced by observing traffic rules and guarantying transport safety.

Common variable immunodeficiency (CVID) is a primary immune deficiency disorder characterized by a failure in B cell differentiation, impaired immunoglobulin production,and defect in response to vaccines. As a result of defective B cell maturation and differentiation in CVID, the affected patients commonly present with reduced numbers of memory B cell and antibody-secreting plasma cells. B-cell lymphoma 6 protein (BCL6) and B lymphocyte induced maturation protein 1 (BLIMP1) molecules are two important transcription factors that have key roles in the maturation of B cells to plasma cells. Hence, in the current survey, we aimed to evaluate the mRNA and protein expression levels of BCL6 and BLIMP1 in B lymphocytes isolated from peripheral blood in CVID patients. We collected blood samples from 12 CVID patients and 12 healthy controls. We isolated peripheral blood mononuclear cells (PBMCs) using Ficoll density gradient separation. Then, CD19+ B cells were purified using MACS. The protein expression and transcriptional level of BCL6 and BLIMP1 were respectively measured using flow cytometry and real-time PCR. Our results showed that the BLIMP1 mRNA expression, as well as BLIMP1 protein expression, were significantly higher in CVID patients compared to control subjects (p=0.009 and p=0.007, respectively). However, we found no significant difference in mRNA and protein expression of BCL6 between patients and healthy controls. According to our findings, increased mRNA and protein expression levels of BLIMP1 could be involved in defective maturation of B cells in patients with CVID and elucidate mechanistic insights into the pathogenesis of this disorder.

Oral health can influence general health and then the quality of life. Regular toothbrushing with toothpaste plays a fundamental role in oral hygiene. The aim of this study was to assess the pattern of utilization of toothpaste among Iranian population.

This cross-sectional study evaluated the family members of patients (n=715) presenting to dental clinics of School of Dentistry of Tehran University of Medical Sciences, in 2017. A researcher-made questionnaire was used to collect information regarding the pattern of utilization of toothpaste by the subjects. Data were analyzed using Chi-square test via SPSS 25.

Of all, 81% participants reported that they personally use toothpaste when toothbrushing and 75.9% stated that all the family members used toothpaste when brushing their teeth. Moreover, 57.2% reported that all the family members shared the same toothpaste; 86.6% reported that they started brushing the teeth of their children at the age of 3 years. When asked about the factors considered when for purchasing - toothpaste, the most important factors were the manufacturing country (42.5%), date of production (38.7%), having standard and authenticity labels (29.5%), the price (29.5%).

According to the results, Iranian families have inadequate knowledge about the correct pattern of use of toothpastes.

The purpose of this paper is to assess the efficiency of existing companies in Iran's insurance industry and its relationship with important profitability ratios. Therefore, with the help of input-axis and output-axis approaches, the performance of the companies was investigated and then the relationship between profitability and efficiency was investigated using Tobit's regression model.

To achieve the answer to the above question, 14 insurance companies in the capital market of Tehran were selected as statistical samples. The data collected in a 10-year period between 2012 and 2018 have been considered and the hypothesis test has been performed by considering the dependent variable of dividend in different forms through tobit and logit regression analysis.

The results confirm that during the six-year period (2011 to 2016), the return on assets with a calculated efficiency is positively correlated with the input-oriented approach and has a negative relationship with the output-oriented approach. The results also show that the return on equity does not have any significant relationship with any of the two performance approaches.

Originality/Value:

In this study, considering the ratio of total liabilities, equity and assets as input variables and income and sales, premium, net profit as output variables, the ability to aggregate these items and translate them into one It has a single criterion called "efficiency" with two approaches.

Primary immunodeficiency diseases (PIDs) is a diverse group of diseases, characterized by a defect in the immune system. These patients are susceptible to recurrent respiratory infections, gastrointestinal problems, autoimmune diseases, and malignancies. In most cases, patients with primary immunodeficiency disorders have genetic defects and are monogenic disorders that follow a simple Mendelian inheritance, however, some PIDs recognize a more complex polygenic origin. Overall, almost 70 to 90 percent of patients with primary immunodeficiency are undiagnosed. Given that these patients are exposing to respiratory infectious agents and some live-attenuated vaccines, thus they have a high risk to some clinical complications. The administration of oral polio vaccine in patients with PIDs especially can increase the possibility of acute flaccid paralysis. These patients will excrete the poliovirus for a long time through their feces, even though they are not paralyzed. Long-term virus proliferation in the vaccinated individuals causes a mutation in the poliovirus and creates a vaccine-derived polioviruses (VDPVs), which is a major challenge to the final stages of the worldwide eradication of polio. To increase the diagnosis and identification of patients with immunodeficiency and carrying out a national plan for screening patients with immunodeficiency from the fecal excretion of the poliovirus, a possible polio epidemic can be prevented during post-eradication. Development of laboratory facilities in provincial and city centers, improvement of communications among physicians regarding medical consultation and establishment of referring systems for patients by national network lead to improve status of diagnosis and treatment of patients with primary immunodefiicencies. In this context, launching and activating the national network of immunodeficiency diseases is essential for improving the health of children and reducing the cost of the health system of the country. A national network of immunodeficiency can lead to increase awareness of physicians regarding primary immunodeficiency disorders, improve collaboration among physicians about genetic consultation and establish a practical referral system in Iran that results in increased diagnosis and improve treatment of patients with primary immunodeficiency disorders.