Introduction: Acute appendicitis is essentially a clinical diagnosis, and there are many places in India where confirmation based on radiological imaging is not available immediately. In such scenarios, clinical scoring system comes handy. Materials and Methods: This paper is based on a study to compare the sensitivity and specificity of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring System and Alvarado Scoring System in the clinical diagnosis of acute appendicitis. There is very little literature about RIPASA Scoring System. Results: The Alvarado Scoring System showed that 6%–12.5% of patients had total score of 5–6 (possible), 31%–64.6% had total score of 7–8 (probable) and 11%–22.9% had total score of 9–10 (very probable). Forty-two patients had a total score of ≥7, which is the cut-off score to be considered for confirming appendicitis. RIPASA Scoring System showed that 43%–89.6% of patients had cut-off score >7.5 (suggestive of appendicitis) and only 5%–10.4% of patients had score <7.5 (other causes). Conclusions: RIPASA Scoring System was more sensitive and specific than Alvarado Scoring System in the clinical diagnosis of acute appendicitis.

Non healing ulcers are a burden to the patient as they are difcult to treat. They also affect patient's quality of life. A series of 2 patients – one with chronic venous ulcer and other with diabetic foot ulcer were included. Epidermal grafts were harvested and applied using Cellutome epidermal harvesting system (KCI) with no anesthesia. After transferring the harvest of epidermal blisters, 4 layer compression bandaging was given. Both the patients tolerated the procedure with no complications involving donor as well as recipient sites. Photographs were taken during various phases of healing. 1 week follow up showed 63% reduction in wound area. Donor site was completely healed by this time. Reduction in ulcer size of upto 99% was seen in 8 weeks.

Though there have been multiple cases of arterial thrombosis and gangrene of limbs reported following COVID-19 infections, there has not been any case reported following COVID-19 vaccinations. Here we reported a case of acute lower limb ischemia following COVID-19 vaccination in a 32 year male with no co-morbidities. The clinical symptoms and signs related to lower limb ischemia started 2 weeks after COVID-19 vaccination. Despite anticoagulation, thrombo embolectomy and intraluminal catheter guided thrombolysis, patient’s left forefoot became gangrenous and had to be amputated.