IntroductionThe WHO estimates a shortage of 18 million health workers (HWs) by 2030, primarily in low-income and middle-income countries (LMICs). The perennial out-migration of HWs from LMICs, often to higher-income countries, further exacerbates the shortage. We propose a systematic review to understand the determinants of HWs out-migration, intention to migrate and non-migration from LMICs.Methods and analysisThis protocol was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guideline for the development and reporting of systematic review protocols. We will include English and French language primary studies (quantitative or qualitative) focused on any category of HWs; from any LMICs; assessed migration or intention to migrate; and reported any determinant of migration. A three-step search strategy that involves a search of one electronic database to refine the preliminary strategy, a full search of all included databases and reference list search of included full-text papers for additional articles will be employed. We will search Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science from inception to August 2022. The retrieved titles will be imported to EndNote and deduplicated. Two reviewers will independently screen all titles and abstract for eligibility using Rayyan. Risk of bias of the individual studies will be determined using the National Institute of Health study quality assessment tools for quantitative studies and the 10-item Critical Appraisal Skills Programme checklists for qualitative studies. The results will be presented in the form of narrative synthesis using a descriptive approachEthics and disseminationWe will not seek ethical approval from an institutional review board, as this is a systematic review. At completion, we will submit the report of this review to a peer-reviewed journal for publication. Key findings will be presented at local and international conferences.PROSPERO registration numberCRD42022334283.

Kommerell's diverticulum is an embryologic developmental anomaly of the aortic arch wherein a diverticulum arises from either the left or the right aortic arch. It results due to the persistence of the remnant of the fourth dorsal aortic arch. We present a case of a 66-year-old female presenting with complaints of throat pain and difficulty swallowing. A computed tomography (CT) scan of the neck with contrast revealed an incidental finding of an aberrant right subclavian artery with associated diverticula of Kommerell, measuring up to 1 cm, causing a mass effect on the esophagus and posterior trachea. A diagnosis of dysphagia lusoria was established, and an upper gastrointestinal (GI) series revealed narrowing of the esophagus from posterior extrinsic compression. The patient was discharged home for nutrition optimization with a percutaneous endoscopic gastrostomy (PEG) tube due to significant weight loss from the inability to swallow before proceeding with surgery to repair the aberrant right subclavian artery.

Background: Fecal microbiota transplantation (FMT) is a promising therapeutic option for managing Clostridium difficile infections (CDI). CDI is a significant health concern, particularly in antibiotic-resistant cases impairing the quality of life among the patient population. This systematic review aims to pool current clinical trial evidence of FMT (RBX2660) success rates when used for recurrent CDI in the clinical trial setting. Methods: In accordance with PRISMA Statement 2020 guidelines, the following databases were systematically searched: Embase, PubMed, and Scopus. There were no time or language restrictions. The following keywords were used in all the databases: fecal, microbiota, transplantation, recurrent, Clostridium difficile, infection, and antibiotic-resistant. Only clinical trials, controlled or single-arm, were included in this systematic review. Results: A total of five clinical trials, of which four were phase II, and one was phase III, were included. Seven hundred ninety-five participants were pooled across all trials. Patients were included in the trials with 1-2 recurrent CDI. In most cases, they had undergone standard antibiotic therapy before enrolling. The treatment success rate in the RBX2660 intervention group was 69.5% (335/482) compared to 49.6% (123/248) in the placebo group. The intervention was safe and effective, with no grade III or higher adverse events reported in treating recurrent CDI. Conclusion: RBX2660, recently approved as a therapy for recurrent CDI in the United States, is a significant milestone in expanding treatment options. This study reports the potential benefits of FMT and other microbiota-based therapies. While many challenges require addressing, including sample control and patient compliance, FMT is heading toward ongoing acceptance in the broad medical community.