Strongyloides stercoralis hyperinfection syndrome (SHS) is a severe complication of strongyloidiasis, typically in immunosuppressed patients. While sepsis and multiorgan dysfunction are well recognized, the association with thrombotic complications remains underexplored. We conducted a systematic review of case reports and case series following PRISMA 2020 guidelines. PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched through December 2024. Eligible studies included patients with SHS or disseminated strongyloidiasis and confirmed thrombotic events. Data on demographics, risk factors, infection characteristics, thrombosis, treatment, and outcomes were extracted and narratively synthesized. Fourteen studies describing 16 cases of SHS with thrombosis published between 2013 and 2024 were included. Median age was 66 years (range 40–87), with a slight male predominance. Most patients (68.8%) were immunosuppressed, primarily due to corticosteroid therapy. Thrombotic events were heterogeneous, including deep vein thrombosis, pulmonary embolism, portal and renal vein thrombosis, intracardiac thrombi, and disseminated intravascular coagulation. Multifocal thrombosis (arterial + venous) occurred in 3/16 (18.8%) cases; shock was present in 5/16 (31.3%). Ivermectin was the mainstay of therapy, alone or with albendazole, although treatment regimens were inconsistently reported. Anticoagulation was frequently initiated, and two cases required thrombectomy. Despite treatment, overall mortality reached 31.3%, particularly among immunosuppressed patients with shock or disseminated thrombosis. SHS can be complicated by diverse and often fatal thrombotic events, especially in immunosuppressed individuals. Clinical suspicion should be heightened in patients from endemic regions or those receiving corticosteroids. Early empiric antiparasitic therapy, timely investigation for thrombotic complications, and individualized anticoagulation strategies are essential to improving outcomes. Given the reliance on case-level evidence, prospective studies and standardized reporting are urgently needed to characterize better risk factors, optimal management, and prognosis of this neglected but critical complication.

Background: Obesity-related dyslipidemia, hypertension, and insulin resistance are major global concerns. Roux-en-Y gastric bypass (RYGB) yields greater weight loss than lifestyle therapy, but its advantage over hypocaloric diets for cardiometabolic risk is uncertain. We compared RYGB with hypocaloric diets in adults with obesity. Methods: We included clinical trials and observational studies that enrolled adults (BMI ≥ 30 kg/m²) and compared RYGB with hypocaloric diets (500–1000 kcal/day deficit). The primary outcome was LDL-cholesterol; the secondary outcomes were HDL-cholesterol, BMI, systolic blood pressure, triglycerides, and HbA1c. Studies with additional procedures or co-interventions were excluded. PubMed, EMBASE, Scopus, Web of Science, and Google Scholar were searched through 1 July 2025. Risk of bias was assessed with RoB 2.0 and the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed. Results: Eight studies (n = 622) met the criteria. Versus diet, RYGB did not significantly reduce LDL-cholesterol (MD −9.52 mg/dL; p = 0.09). Trends favored RYGB for BMI (MD −4.02 kg/m²; p = 0.06) and triglycerides (MD −18.58 mg/dL; p = 0.06). Changes in HDL (+2.81 mg/dL), systolic blood pressure (−2.77 mmHg), and HbA1c (−0.22%) were small and non-significant. The certainty of evidence was low across outcomes. Conclusions: Current evidence does not demonstrate superiority of RYGB over hypocaloric diets for cardiometabolic risk markers. Dietary therapy remains first-line; RYGB may be considered for selected patients.

Introduction: Black widow spider (Latrodectus mactans) envenomation is a medical challenge in regions with limited access to standardized treatments. This study analyzes a series of 10 cases that occurred in Matagalpa, Nicaragua, highlighting the diagnosis and treatment of patients. Description of the cases: Over a nine-year period 10 hospitalized patients, mostly adolescents (60%) and males (90%) from rural areas, were attended. Severe cases made up 30% of the total and included symptoms such as abdominal pain, neurogenic shock, and vomiting. Laboratory findings showed leukocytosis and lymphopenia in 50% of the patients. In terms of management, 60% received Aracmyn Plus antivenom, in addition, corticosteroids, antihistamines, and non-steroidal analgesics were used in most cases. There were no adverse reactions to antivenom treatment. All patients were discharged with no mortality. Discussion and conclusion: The lack of knowledge of this disease and the limited availability of antivenom, poses significant challenges to the effective management of latrodectism in the region. Although analgesic treatment was effective in most cases, some patients required intensive care. This highlights the need for studies that reflect local experience in managing this disease. Furthermore, this case series emphasizes the importance of publishing clinical reports in areas where latrodectism has been little investigated. These data are fundamental to generating evidence to optimize treatment and establish specific protocols in Nicaragua and similar regions.

Sexually transmitted infections during pregnancy are associated with important maternal, fetal, and neonatal complications, including vertical transmission, congenital infection, stillbirth, preterm birth, and increased maternal morbidity. Pregnant migrant and refugee women may face additional risks because displacement, legal precarity, socioeconomic vulnerability, and limited access to antenatal care can delay screening and treatment. However, the burden of sexually transmitted infections in this population remains poorly characterized, and available estimates are fragmented across geographic regions, migration categories, diagnostic methods, and healthcare settings. Objective: This systematic review and meta-analysis aims to estimate infection-specific prevalence of sexually transmitted infections among pregnant migrant, refugee, asylum-seeking, undocumented, internally displaced, or otherwise displaced women worldwide and to characterize variation by geographic region, migration status, and other clinically relevant factors. Methods: This protocol is registered in PROSPERO (CRD420251085346). We will include peer-reviewed primary cross-sectional studies and cohort studies with a defined prevalence denominator, while excluding case reports, case series, case-control studies, grey literature and reports without a valid denominator. MEDLINE via Ovid, Embase.com, Scopus, Web of Science, the Virtual Health Library, and the WHO Global Index Medicus will be searched without language, date, or geographic restrictions and citation searches. Two reviewers will independently screen records and extract data using a prespecified form that will be pilot-tested before formal extraction. Risk of bias will be assessed with the Joanna Briggs Institute prevalence checklist. When at least three comparable independent estimates are available, random-effects meta-analysis will be conducted separately for each infection. A participant-level composite of any STI will be analyzed only when explicitly reported using unique individuals and will not be derived by summing infection-specific cases. Certainty will be evaluated using a GRADE-informed approach adapted for prevalence estimates.