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The funnel plots were performed to check a part of the reporting bias and a part of the heterogeneity, and there were low risk of the reporting bias and no issues with heterogeneity

A well-designed plan should have a clear reason for every treatment, realistic expectations, and a way to monitor benefits and side effects

Future well-designed, prospective studies with larger sample sizes and comprehensive baseline assessments are essential to validate these results, minimize potential biases, and establish the efficacy, safety, and optimal dosing of L-carnitine supplementation in this population

Skipping steps or escalating faster than prescribed dramatically increases vomiting risk