Key Clinical Message Complete Primary Pachydermoperiostosis is a rare syndrome that presents with skin and skeletal manifestations. Though diagnosis can be made on the basis of the classic clinical and radiological features, it is often missed due to variable presentations. Therefore, it is important to know about this syndrome to reach correct diagnosis.

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Background: Organ donation gives thousands of patients a renewed chance at living full and active lives. Unfortunately, the need for organs does not match their availability. This study aims to analyze the effect of demographic factors on the knowledge and awareness of the Jordanian society towards organ donation. Methods:This cross-sectional study was conducted using a self-administered online questionnaire. We included 1041 adult Jordanians from all the governorates of the Hashemite Kingdom of Jordan. Results:Of the 1041 participants, only 124 (11.9%) had previously singed organ donation card.Overall, 827 (79.4%) were fully accepting organ donation. Among 782 participants in the medical field, 639 (81.7%) fully accepted organ donation, compared to 188 out of 259 (72.6%) in the non-medical field (p= 0.002), with no significant effect of any demographic factor on the willingness to sign organ donation card. There was significant difference in the acceptance of donation from brain dead donors (p< 0.001), with participants from medical field and male participants having higher acceptance rates when compared with non-medical and female participants, respectively. The main barrier for organ donation was found to be the desire to be buried as a whole (58.2%), followed by traditional beliefs (47.4%), and family refusal (42.2%). 2Published by SCHOLINK INC. Conclusions:In conclusion, an educational strategy can improve organ donation awareness from an early age by spreading actionable information through social media and conducting nationwide public campaigns.

Background: Previous studies have confirmed the association between biliary disease and bariatric operations. Biliary complications may include cholecystitis, biliary pancreatitis, cholangitis, biliary polyps, biliary sludge and gallstones. It is believed that cholelithiasis is the result of increased biliary stasis due to alterations in the enterohepatic circulation and hormonal changes associated with weight loss. However, research regarding predictive factors other than the percentage of excess weight loss (EWL) is limited. In addition, preventive measures of gallstone formation and potential related complications are still debated. Aim: The goal of this article is to assess the predictive factors of biliary complications after laparoscopic sleeve gastrectomies (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to review the possible need for future surveillance via radiological studies. Method: ology: A retrospective review of 118 patients who underwent LSG and LRYGB between 2015 and 2016 in Jordan University Hospital (single centre) was performed in order to complete this cohort study. Patients with previous cholecystectomies or biliary disease prior to bariatric operations were excluded from the study. Utilizing the hospital's electronic records system, patients were contacted by telephone and were asked a series of questions listed in a custom-made questionnaire. Results: Mean age ± SD was 34.9 ± 12.0 years old (68.64% Females). Eleven patients (9.32%) underwent LRYGB, 100 patients underwent LSG and seven patients underwent both, with a preoperative mean body mass index (BMI) ± SD of 45.2 ± 6.3. 29 patients (24.58%) developed postoperative biliary complications. The main biliary complications were as follows: biliary pancreatitis (0.85%), biliary polyps (0.85%), biliary sludge (0.85%), cholecystitis/gallstones (22.03%). Conclusion: In conclusion, it was found that approximately 24.58% of patients have post-operative late biliary complications. Of these patients, predictive factors other than EWL were not significant enough to recommend prophylactic screening via radiological studies. Highlights