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Background: All members of society should have equal access to necessary health care. The main goal of this research is to determine the status of health care access in eight selected countries and to suggest a new model for Iran. Materials and Methods: This study was done comparatively on eight countries. In order to define a framework for categorizing the countries Jordan scales was employed. In this method, based on the kind of insurance system, countries are divided into 4 groups, from each 2 countries were selected. Data obtained from each country were placed in comparative tables. For presenting the final model, Delphi technique was utilized in two stages. Results: To increase equity in their health care systems, all the countries in this study utilized such strategies as insurance coverage for all, defined health care packages, appropriate human resources, family physicians, referral system and high level of GNP in health sector. Also, low direct payment by patients, expansion of insurance coverage and the existence of out of pocket pay limit in pharmaceutical and medical services were also very helpful. These policies have been made in a way that the level of individuals' income did not affect the access to such services. Conclusion: Equitable access to health care services in Iran necessitates the establishment of national health insurance system aiming at omission of parallel insurance, provision of medical care coverage for all the basic medical services especially health care coverage for the elderly and patients with chronic psychological problems.

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Background: Ischemia/reperfusion-induced acute renal failure causes excretory functional disorders of nephrones. Ischemia/reperfusion injury increases iNOS expression in the renal tissue. Inhibition of iNOS expression and its activity can ameliorate ischemia/reperfusion-induced renal injury. The aim of this study was to determine the role of iNOS on progression of renal functional disturbances over the immediate post-ischemic reperfusion period. Materials and Methods: In this experimental study, renal hemodynamic and excretory functions were evaluated in male Sprague-Dawley rats. First, a 30-min control clearance period was taken. Then following bilateral renal artery clamping for 30 minutes, four consecutive 30-min clearance periods were taken during reperfusion, while saline or L-NIL as a selective iNOS inhibitor was infused. In plasma and urine samples, Cr and sodium concentration levels were measured. Results: Renal ischemia for 30 minutes decreased glomerular filtration rate and urine osmolality during reperfusion and increased urine flow and sodium excretion. L-NIL did not change the glomerular filtration rate and urine osmolality prior to ischemia but it improved them during reperfusion and there were progressive increases in urine flow. Additionally, L-NIL lowered ischemia-induced rises in sodium excretion. Conclusion: iNOS had a considerable role in the development of disorders in hemodynamic and excretory renal functions during early hours after ischemia.

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Background: The effectivity of applying antiseptics in preparation of the operative site on the reduction of post-operative infections is not quite clear and controversies exist about the best method for doing this. The aim of this study is to compare the traditional two-stage method of first, washing the site with povidone iodine scrub and then painting with aqueous povidone iodine with the method of washing the site only with povidone iodine scrub. Materials and Methods: In this retrospective study, patients who had been under knee arthroscopy in 2 separate hospitals by the same surgeon were compared with regard to post operative infection. In one hospital, the operative site was only washed with povidone iodine scrub, while in the other hospital this same procedure was followed by painting with aqueous povidone iodine. The primary goal of this study was to identify the patients who had manifested clinical and laboratory signs of superficial or deep infection or septic arthritis one month postoperatively. Results: A total 300 patients were studied in two equal groups. All the patients had only been under diagnostic or curative non-bony operations. No superficial or deep infection or septic arthritis were seen in any of the patients in the two groups. Conclusion: Preoperative preparation of the knee with povidone iodine scrub is a safe method for prevention of infection and can be used instead of the common two-stage method of using povidone iodine scrub and then painting with aqueous povidone iodine since this can decrease the time and cost of surgery.

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Background: Myopia is the most common refractive defect and degenerative myopia is one of the five causes of blindness in the world. The aim of this study is to examine degenerative myopia and its related risk factors. Materials and Methods: In this cross-sectional study, the data was collected through a questionnaire along with the auto-refraction apparatus, which was utilized for determining the myopic degree. The inclusion criteria for this study were the age above the 10, myopia or astigmatic myopia, apparent media (in fonduscopic examination), and the absence of age related retinal defect. Results: A total 65 patients participated in this study 51% of whom had degenerative myopia. Choroid neovascularization was observed in 17.65% of the subjects. There was a significant difference in the relationship between hypertension(r=28%), diabetes mellitus (r =22%) and glaucoma, and degenerative myopia however, this difference was not observed between cataract and myopia. The correlation coefficients between hypertension and diabetes mellitus, and degenerative myopia were 28% and 22%, respectively. This correlation was very low in the case of glaucoma. The greatest correlation existed between the myopic crescent and hypertension (r=0.295%). In all of the cases, the correlation coefficient between diabetes mellitus and all the myopic complications was positive but below 40%. Conclusion: The majority of the patients had degenerative myopia. Hypertension and diabetes mellitus were the most common co-existing diseases. Noticing the correlation coefficient existing between hypertension and myopia, the need for controlling hypertension and diabetes mellitus for preventing retinal complications is emphasized. Also, for preventing the adverse effects of degenerative myopia in retinal defects, controlling glaucoma is suggested.

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Background: Clinical research suggest a relationship between epilepsy and hypogonadism. The aim of this study is to identify the impact of epilepsy induced by kindling with pentylenetetrazol (PTZ) on hormones and some reproductive parameters in male rats. Materials and Methods: Adult male rats (NMRI strain) were divided into control and kindling groups. Kindling was induced by 40 mg/kg PTZ with a 48 hour interval through intraperitoneal injection. Each animal received 13 doses. At the end of the thirteenth dose, animals were weighed and uthenaized with ether and blood samples, collected from their hearts, were used for testosterone, prolactin and FSH, LH assay. In order to examine motility and morphology of sperms, tissue samples from epidydimis were isolated and minced in DMEM/F12 culture medium and were incubated for 15 minutes. Then sperm morphology and motility were studied. Testis were also isolated and weighed. Results: Kindling with PTZ decreased serum levels of testosterone and LH, but it increased rolactin. However, there was no difference in serum level of FSH between the two groups. Sperm motility in kindling group decreased significantly. There were no significant differences in testis weight, but the amount of animal weight losses in the kindling group was more than that of the control group. Conclusion: By changing the serum level of sexual hormones and decreasing sperm motility, PTZ kindling induced epilepsy exerts diminishing negative effects on reproduction.

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Abstract Background: Misconceptions of mental models are phenomena that are variance with accepted scientific models. Purpose of this study was to investigate the prevalence of misconception about half life and concentration of insulin hormone in students of Arak university of medical sciences. Materials and Methods: In this descriptive study 153 undergraduates in medicine and nursing – midwifery faculties of Arak university of medical sciences in 2009, were asked to answer to two questions about half life and concentration of insulin hormone. Results: The prevalence of misconception about half life of insulin hormone in medical, nursing and midwifery students were 75%, 80% and 85%, respectively, and prevalence of misconception about insulin concentration in blood were 31%, 26% and 20%, respectively. Conclusion: Misconceptions about insulin half life and concentration exist in high percent of students and it is necessary to correct the teaching pattern.

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Background: The purpose of this study was to determine the effect of L-carnitine supplementation on glucose and lactate concentrations, and aerobic capacity during sub-maximal exercise on ergometery cycle. Materials and Methods: In this double- blind clinical trail, 34 healthy noathlete male students at Saveh University were divided into experimental (L-carnitine usage) and placebo (lactose usage) groups and had one trial of cycling on ergometer (PWC170). This trial was done in two stages: 1) Exercise protocol without L-carnitine or placebo supplementation, 2) Exercise protocol with 3g L-carnitine (90 minute before exercise) and placebo supplementation in the experimental and placebo groups, respectively. Immediately after the physical exercise, blood sampling was taken for determining plasma glucose and lactate concentrations, and lactate dehydrogenase activity (LDH). Through polar telemetry rest and sub-maximal heart rate, and also, VO2max were measured. Results: L-carnitine supplementation had no influence on plasma glucose and lactate concentrations. Otherwise, rest and sub-maximal heart rate, VO2max and LDH activity were equal in pretest and posttests. All variables remained with no change in control group. Conclusion: Regarding the effect of L-carnitine usage on performance of endurance exercises, the findings are still vague and controversial. Our findings indicated that ingestion of 3g L-carnitine 90 minutes before exercise did not affect the dependent variables. Further investigation is required to determine the direct effect of such supplementations on substrate utilization, fat-carbohydrate metabolism and performance on exercise.

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Background: Following the reduction of neurons due to peripheral nervous injuries, the number of neuroglial cells also decline because of not receiving vital factors. The aim of this study was to determine the protective effects of curcuma longa total extract on spinal cord neuroglia cell degeneration after sciatic nerve compression in rats. Materials and Methods: In this experimental clinical- trial, Wistar rats were categorized in five groups (control, compression, treatment1, treatment 2 and treatment 3), each including six rats. For inducing the injury in the compression and treatment groups, the right sciatic nerve in the upper thigh was compressed using clamp forceps. In the treatment groups, 100mg/kg doses of the extract were injected in group1(3 times a day), group 2 (6 times a day) and in group3 ( 9 times a day). After 28 days, following being anesthetized, the rats underwent perfusion and samples were taken out of the lumbar segments of their spinal cord. Then the samples, after going through tissue processes, were cut in 7 m serial sections and stained in blue toluidine. Through the stereological quantitative technique, neuroglial cells were counted. Results: A significant decrease was seen in the number of neuroglial cells in the compression group (6913±208) in comparison with the control group (10184±791). Also, through the comparison of the compression group with treatment group 1(7077±293), treatment group2 (9372±252) and treatment group 3 (8715±252) a significant difference among dnsity of neuroglial cells in groups and 3 with conppnessin group was seen. a remarkable increase in the numerical density of neuroglial cells was obtained (p<0.05). Conclusion: Due to its antioxidant effects, curcuma longa extract increased the numerical density of neuroglia cells following the compression of the sciatic nerve. The antioxidant effects of this extract probably inactivate the apoptosis channels which have been activated due to peripheral nerve injuries.

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Background: Identifying the problems which exist in clinical education and setting to solve them will lead to the improvement of quality of medical care services. This study was conducted to fulfill this goal. Materials and Methods: In this descriptive–analytic research which was carried out in 2008, the views of the medical trainees and interns, who had at least gone through two major clinical courses at Arak University of Medical Sciences, about the obstacles of clinical education were evaluated. For achieving this purpose, a questionnaire containing 56 questions on 6 problem areas including clinical education spaces, educational facilities, cooperation of health and treatment personnel, clinical assessment and teaching methods, and clinical curriculum design methods was administered. Results: The quality of clinical education in the view of 41% of medical trainees and 48% of interns was seen to be at an average level. Assessment methods of clinical education, on the other hand, were rated as weak by 28.7% of trainees and 32% of interns. Also, 29.3% of trainees and 31.7% of interns evaluated the use of educational spaces to be at a weak level. Additionally, the quality of clinical teaching methods, educational facilities, cooperation of health and treatment personnel, and the design of clinical curriculum were seen at an average level. Conclusion: This study highlighted the importance of determining learning experiences, applying proper teaching methods, conducting continuous generative evaluations, using simulated environments and educational spaces congruent with graduates’ future employment opportunities, and enhancing students’ level of motivation, as effective strategies for the improvement of the quality of medical education.

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Background: This investigation was designed to determine the effects of a selective A1-AR antagonist (DPCPX) on renal hemodynamic and excretory dysfunctions induced during the early hours of ischemia/reperfusion (I/R). Materials and Methods: In this experimental research, rats were anaesthetized by sodium pentobarbital, and their renal arteries were, then, occluded for 30 min, four hours after the reperfusion period. There was a clearance period during the last one hour of reperfusion period throughout which urine was collected under 30-mm of paraffin, and arterial blood samples were taken during its beginning and end. Animals were divided into four groups DPCPX (2 mg/kg) or normal saline were injected 30 min before renal ischemia to the two groups of I/R+DPCPX and I/R, respectively, and to DPCPX and Sham groups which were subjected to surgery without clamping of renal arteries, respectively. Results: I/R resulted in elevations of plasma osmolality, plasma concentrations of Na, K, creatinine, and urea, fractional excretions of Na, K, and bicarbonate, absolute bicarbonate excretion, and urinary pH, but it induced reductions in arterial bicarbonate concentration, pH and Pco2, creatinine clearance, absolute excretions of Na and urea, free-water re-absorption, and urinary osmolality in the I/R group in comparison to the Sham group. Comparison between I/R+DPCPX and I/R groups showed that applying DPCPX could improve I/R-induced alterations in most of these parameters. Conclusion: Activation of A1-AR during the early hours of reperfusion following renal ischemia definitely contributes to the development of disorders in hemodynamics, tubular Na re-absorption, as well as excretions of K, urea, and acid-base.

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Background: Salvia staminea, belonging to lamiaceae family, has positive effects on the nervous system and possesses anti-oxidant and anti-inflammatory effects. Hence, this study was conducted to determine the neuro-protective effects of salvia and its total ethanol extract on spinal cord motoneurons in Wistar rats. Materials and Methods:In an experimental trial, 54 male Wistar rats were divided into nine groups of six: Control, compression, treatment A (ethanol extract of root in 25, 50, and 75 mg/kg doses), treatment B (aqua extract of root in 25 and 50 mg/kg doses), treatment C (aqua extract of leaves in 50 mg/kg doses), and treatment D (ethanol extract of leaves in 75 mg/kg doses). In compression and treatment groups, 28 days after inducing impairment in α motoneurons, sampling of the left leg sciatic nerves was done in the rats. Following tissue passage, 7 micron cuts were obtained and painted with blue toluidine. Neuralgia motoneurons count was, then, carried out through steriology and dissector methods. Results: Neuron number density in the rats treated with 50 mg/kg doses of total aqua and ethanol extracts of leaves and 75 mg/kg dose of ethanol extract of root showed significant differences in comparison to that of the compression group (p<0.05). Conclusion: The results of this study prove the neuroprotective effects of these extracts on neuralgia motoneurons of spinal cord.

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Background: Among respiratory support techniques, nasal continuous positive airway pressure (NCPAP) and mechanical ventilation (MV) are more known for their effectivity in reducing complications associated with respiratory distress syndrome (RDS). Moreover, early application of NCPAP and administration of surfactant are effective in decreasing the need for MV and its adverse effects. This study was designed to compare NCPAP and MV after administration of surfactant in preterm neonates with RDS. Materials and Methods: In this clinical trial, 60 preterm neonates (<32 weeks) were evaluated. After receiving one dose of surfactant (4 cc/kg), the subjects were randomly divided into treatment and control groups, and respiratory support was established via positive airway pressure or MV. Results: There were no significant differences between the neonates in the two groups in terms of gestational age and birth weight. The mean duration of MV was significantly lower in the treatment group (p=0.001). On day 3, the number of ventilator-dependent neonates in the control group was more (26.7% versus 83.3%). There were no significant differences between the two groups in the number of second surfactant doses, mortality rate, and the number of patients who had developed short-term complications during hospital stay. Conclusion: In a significant number of preterm babies with RDS, NCPAP can be extubated after receiving one dose of surfactant. This is a potentially useful modality for respiratory support with a low mortality and morbidity rate and limited complications in very premature infants.

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Background: Hospital wastewater usually contains pathogenic micro-organisms, drugs, radio active materials, and toxic chemical elements that in case of being disposed without filtration, will result in pollution and spread of diseases. Therefore, evaluating the status of wastewater disposal in hospitals is necessary for proper planning. Materials and Methods: In a cross-sectional descriptive study in 2008, data collection was done by means of interviews, observations, and questionnaires in all hospitals of Markazi Province. Noticing the 33 items in the questionnaire, the overall conditions of the hospitals and the methods of using the sewage system were studied, and at the same time, filtration installations and wastewater disposal systems were inspected. Results: Of all the 19 hospitals, 10 used a conventional method of direct disposal of sewage to subterranean shafts, and of the 4 hospitals with filtration installations, three were practically out of order or were not efficient. Five of the hospitals were directly linked to the city sewage system without any pre-filtration. None of the hospitals had a specialized operator of sewage filtration and disposal system. Conclusion: Wastewater disposal in hospitals of Markazi Province is not desirable therefore, such acts as conducting more specific surveys, creating a positive attitude in planners, and providing sufficient funds for filtering wastewater in some of the hospitals are suggested.

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Background: Pain following tonsillectomy is common in children, and its elimination due to its subsequent complications is essential. Therefore, this study was conducted with the aim of obtaining the best method of administering ketamine for reducing pain following tonsillectomy with the greatest efficiency and the least side effects. Materials and Methods:This study was a double-blind clinical trial which was conducted on 92 children, aged 3-9, who had been admitted for tonsillectomy. The patients were randomly divided into oral ketamine and ketamine injection groups (each containing 46 patients). Thirty minutes before the operation, all the patients were given apple-juice ketamine injection group received normal apple juice without ketamine, whereas the oral ketamine group received 5mg/kg ketamine with the apple juice. Three minutes before tonsillectomy, 0.5 mg/kg ketamine was injected to the peritonsillar area in ketamine injection group while the same volume of saline was injected to the oral ketamine group. Data were registered, gathered, and, then, analyzed using Wilcoxon, Man Whitney, and t tests. Results: Demographic data and blood pressure before and after the operation did not have significant differences in the 2 groups. In terms of the duration of operation time, a significant difference was observed between the two groups the operation time in the ketamine injection group was shorter (p=0.006). Also, pain score in the ketamine injection group was less than the oral ketamine group. Conclusion: Ketamine is effective in reducing the pain after tonsillectomy operation. Peritonsillar injection of ketamine is more effective than its oral usage.

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Background: Postoperative ileus after appendectomy causes gas storage, distention, nausea, vomiting, and even pain. Gum chewing is one of the ways that can reduce the duration of temporary ileus. The aim of this study is to determine the effect of gum chewing on bowel movements following appendectomy. Materials and Methods: This randomized double-blind clinical trial was done on 46 patients undergoing appendectomy that were divided into equal treatment and control groups. The treatment group chewed gum three times, each time for 20 minutes, 4, 10 , and 18 hours after recovery from anesthesia. The control group, however, did not receive any special treatments. The bowel sounds were monitored every two hours using stethoscope. Also, through running interviews with two hour intervals, data were collected regarding the first passage of flatus and defecation. Data were analyzed through SPSS and t-test. Results: On average, the first bowel sounds in treatment and control groups were, respectively, heard at 2.08±0.41 and 3.13±1.45 hours, whereas gas passage in treatment and control groups was reported at 26.8±14.59 and 50.08±13.92 hours, respectively. Also, the first defecation in the treatment group occurred at 18.91±10.77 hour but in the control group this happened at 29.21±12.11 hour. Based on these observations, a significant difference was seen between the two groups in terms of the test results (p=0.002). Conclusion: The findings of this study showed that chewing gum can help bowel movements after appendectomy.

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Background: Spontaneous rupture of tendon is a rare disease that often occurs following an underlying disease or drug usage. However, the association of this condition with primary hyperparathyroidism has rarely been reported. Case: In a case-study, two cases of spontaneous tendon rupture associated with primary hyperparathyroidism are reviewed. The first one is a middle-aged woman that due to bilateral patellar tendon rupture is operated for secondary repair and augmentation of tendons. The second one is a middle-aged man with unilateral triceps brachii tendon rupture who has been operated for primary tendon repair. Conclusion: Since paramount force is needed for tendon rupture, in spontaneous tendon rupture cases, patient evaluation for detecting underlying diseases and drug usage is necessary. In cases that the history of an underlying disease is not indicated, evaluation of serum level concentrations of Ca, P, ALP, and PTH is recommended for contraindication of primary hyperparathyroidism.

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Background: Central giant cell granuloma (CGCG), also known as giant cell reparative granuloma, is a non-neoplastic proliferative lesion with unknown etiology which commonly occurs in the right side of the mandible. This lesion presents a wide variety of radiological and clinical manifestations that may lead to misdiagnosis. In many situations, CGCG is diagnosed through histopathological examinations. Case: In this study, a case of CGCG with irregular clinical and radiological aspect arising from the anterior, left side of the maxilla was reported. Conclusion: In differential diagnosis of swellings arising from the anterior portion of the maxilla, the possibility of CGCG should be considered. Also, histopathological examinations are of great importance in the diagnosis of CGCG.

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Background: The main advantage of regional anesthesia is the elimination of post-operative pain without the need for narcotics, which leads to a more rapid outpatient recovery and faster return to consciousness in pediatric patients. The aim of this study was to compare caudal anesthesia with midazolam and neostigmin co-administered with bupivacain in reduction of post-operative pain in lower abdominal surgery in pediatrics (2- 8 years old). Materials and Methods: In a double-blind clinical trial, 45 pediatric patients were randomly allocated to midazolam, neostigmine, and placebo groups. Induction of anesthesia was done with inhalation of halothane and O2. Bupivacaine 0.25% in 0.5 ml/kg with midazolam in 50μ/kg was administered in caudal form to the first group, and bupivacaine 0.25% in 0.5 ml/kg with neostigmine in 2 μg/kg dose was administered to the second group. The third group received the placebo plus bupivacaine 0.25% in 0.5 ml/kg. Results: Mean durations of analgesia in neostigmin, midazolam, and placebo groups were 16.5± 0.25, 12.3±0.22, and 6±0.11 hours, respectively (P<0.001). Also, in the neostigmin group, mean score of pain in outpatient recovery 6 , 12 , 24 hours post operatively was less than that in the other two groups (P<0.001). Conclusion: Duration of analgesia period in neostigmin group was more than that in midazolam and placebo groups

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Background: Molybdenum is an essential trace element for both animals and plants. Molybdenum (Mo), which functions as a cofactor for a limited number of enzymes including xanthine dehyrogenase, aldehyde oxidase, and sulfite oxidase in mammals, is believed to be an essential trace element in animal nutrition. The aim of this study is to evaluate the hepatoprotective potential of sodium molybdate against carbon tetrachloride (CCl4) induced liver damage. Materials and Methods: In an experimental study, adult male rats received daily oral administrations of different doses of sodium molybdate (0.05, 0.1, and 0.2 g/kg bw) along with intrapertioneal CCl4 (50% CCl4 in olive oil, 1 ml/kg bw) twice a week for 28 consecutive days. Results: Histopathological examinations in CCl4-treated rats showed extensive liver injuries characterized by extensive hepatocellular degeneration and necrosis, fat degeneration, and inflammatory cell infiltration while histopathological changes induced by CCl4 were significantly attenuated by sodium molybdate treatment. Conclusion: The results of this study suggest that sodium molybdate could protect liver against the CCl4-induced oxidative damage in rats, and this hepatoprotective effect might be contributed to the protection of liver by preventing the toxic chemical reactions which generate oxidative stress, lipid peroxidation, and molecular changes which ultimately lead to liver tissue necrosis.

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Background: Molybdenum is an essential trace element for both animals and plants. Molybdenum (Mo), which functions as a cofactor for a limited number of enzymes including xanthine dehyrogenase, aldehyde oxidase, and sulfite oxidase in mammals, is believed to be an essential trace element in animal nutrition. The aim of this study is to evaluate the hepatoprotective potential of sodium molybdate against carbon tetrachloride (CCl4) induced liver damage. Materials and Methods: In an experimental study, adult male rats received daily oral administrations of different doses of sodium molybdate (0.05, 0.1, and 0.2 g/kg bw) along with intrapertioneal CCl4 (50% CCl4 in olive oil, 1 ml/kg bw) twice a week for 28 consecutive days. Results: Histopathological examinations in CCl4-treated rats showed extensive liver injuries characterized by extensive hepatocellular degeneration and necrosis, fat degeneration, and inflammatory cell infiltration while histopathological changes induced by CCl4 were significantly attenuated by sodium molybdate treatment. Conclusion: The results of this study suggest that sodium molybdate could protect liver against the CCl4-induced oxidative damage in rats, and this hepatoprotective effect might be contributed to the protection of liver by preventing the toxic chemical reactions which generate oxidative stress, lipid peroxidation, and molecular changes which ultimately lead to liver tissue necrosis.