Background and purpose: Peripheral neuropathy is one of the most prevalent and undesirable side effects of taxane-containing chemotherapy regimens. This study aimed to investigate the effect of acetyl-L-carnitine (ALC) on the prevention of taxane-induced neuropathy (TIN). Experimental approach: MEDLINE, PubMed, Cochrane Library, Embase, Web of Science, and Google scholar were systemically applied as electronic databases from 2010 to 2019. The current systematic review was carried out based on the main considerations of PRISMA preferential reporting items for systematic review and meta-analyses. Since there was no significant discrepancy, the random-effect model was used for 12-24 weeks’ analysis (I 2 = 0%, P = 0.999). Findings/Results: Twelve related titles and abstracts were found during the search, 6 of them were excluded in the first phase. In the second phase, the full text of the remaining 6 articles was comprehensively evaluated and 3 papers were rejected. Finally, 3 articles complied with the inclusion criteria and pooled analyses. The meta-analysis showed a risk ratio of 0.796 (95% CI between 0.486 and 1.303), so, the effects model was used for 12-24 weeks’ analysis (I 2 = 0%, P = 0.999) since no significant discrepancies were observed. There was no evidence of ALC’s positive effect on the prevention of TIN during 12 weeks, and it was revealed that ALC significantly increased TIN in 24 weeks. Conclusion and implications: According to our findings, the hypothesis that ALC had a positive effect on preventing TIN in 12 weeks has not been proved; however, ALC led to an increase in the TIN in 24 weeks.

Adult onset still's disease (AOSD) is a rare autoinflammatory disease displaying with a wide range of non‐specific symptoms and budd‐chiari syndrome (BCS) is an uncommon disorder characterized by obstruction of hepatic venous outflow. We present the case of a young patient who presented with persistent fever, sore throat, elbow, hand fingers and knees arthralgia with abdominal pain. The patient's symptoms had started 7 days before the referral. Imaging and laboratory data led to the diagnosis of BCS in the context of AOSD. The patient treated with corticosteroid in combination of warfarin with favorable outcome and complete improvement of signs and symptoms. We came to this conclusion AOSD complicated with BCS is a rare but potentially life‐threatening entity. Clinicians should be aware of this complication.

Introduction: Ineffective esophageal motility (IEM) is an esophageal motility disorder (EMD) and the most prevalent abnormality routinely observed in esophageal manometry. Objectives: In this study, we investigated the clinical characteristics of IEM patients and the effects of proton pump inhibitors (PPI) and surgical treatments on their conditions. Patients and Methods: This cross-sectional study was conducted in Isfahan in 2019-2020 on 40 patients diagnosed with IEM. We collected patient demographic information (age, gender, previous medical history, medications, and duration of the current problem) and clinical manifestations (clinical symptoms of patients including dysphagia, heartburn, food and acid regurgitation, chest pain and belching) prior to and following PPI or surgical treatment. Results: Approximately 65% of patients presented with dysphagia and heartburn, 55% had food and acid regurgitation, 47.5% had belching, and 55% had chest pain. Post-treatment findings revealed that only the recurrence of food and acid regurgitation was significantly lower in the PPI treatment group than in the surgical group. Only dysphagia severity was statistically significant in the surgical group compared to other symptoms (P=0.042). In the PPI group, the severity of heartburn (P=0.007), dysphagia (P<0.001), food and acid regurgitation (P=0.007), and chest pain (P=0.027) decreased significantly compared to baseline. Conclusion: This study showed that the common clinical manifestations of IEM were dysphagia, heartburn, food and acid regurgitation, and belching. Moreover, treatment with PPI resulted in more significant improvements than surgical treatment.

Ovarian artery aneurysm is a rare asymptomatic condition usually diagnosed when it ruptures. It causes massive bleeding, often in the peripartum period of multiparous women, who are already at an increased risk for thromboembolic events. Balancing the bleeding risk against the thrombotic complications remains unexplored in such cases. A 35-year-old woman presented with hemorrhagic shock 3 days after delivering her seventh healthy child. During the emergent exploratory laparotomy, she responded well to the blood transfusion; the stable retroperitoneal hematoma indicated no need to explore it. A subsequent episode of hemodynamic instability necessitated another laparotomy, during which the hematoma was evacuated and both ovarian arteries were ligated. Shortly thereafter, the patient suffered a pulmonary embolism (PE). In multiparous patients presenting with peripartum retroperitoneal hematoma and hemorrhagic shock, exploring the hematoma and ligating the ovarian and uterine arteries may reduce the risk of PE or the need for reoperation.