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The novel COVID-19 disease, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, apart from its respiratory complications and coagulopathy, is also involved in damage to other organ systems. We present a report of presumptive case of COVID-19 positive patient with no respiratory symptoms with superior mesenteric vein and portal vein thrombosis along with acute intestinal ischemia. The patient underwent exploratory laparotomy, resection of the ischemic bowel loops with proximal ileostomy and distal mucous fistula. The case highlights that despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms.

BACKGROUND: High altitude induced prothrombogenic state in the human body predisposes to many disease process. Acute appendicitis in the setting of high altitude is also attributed partly to thrombosis of the appendicular artery and its branches and maybe an independent factor contributing to the development of acute appendicitis. Studies on this aspect are non-existent and requires more research. AIM:To study the role of high altitude induced prothrombogenic state in the pathogenesis of acute appendicitis in high altitude. MATERIALS AND METHODS: This was a retrospective observational study on 172 cases of acute appendicitis who presented to our peripheral hospital in the setting of the high altitude terrain of Laddakh between June 2019 to August 2021. Data collection was ostensibly done using the operative ndings as endorsed in the case sheets looking specically for presence of thrombosis of the appendicular artery and its branches on gross examination. RESULTS: 247 cases of acute appendicitis who underwent emergency open appendectomy were examined of which 172 underwent open appendectomy and 75 underwent laparoscopic appendectomy. Only the 172 cases undergoing open appendectomy were considered for the study. The age group under study was 20 to 60 years with a median of 28 years. A signicant 43 cases (25%) were found to have a thrombotic pathology with visible thrombosis of appendicular artery or its branches. CONCLUSIONS: Exposure of high altitude to the individuals living there-in incites a prothrombogenic state in them leading to development of acute appendicitis and the thrombosis of the appendicular artery and/or its branches, has a major contributory independent factor in the etiopathogenesis of acute appendicitis considering the low ow end arterial nature of the same.

Onychomadesis is an anomaly of nails characterized by shedding of nail plates due to temporary arrest in the activity of the nail matrix. Systemic or local factors ranging from acute febrile illnesses, auto-immune diseases, drugs, chemotherapy, trauma, etc., have been known to cause onychomadesis. We report a unique case of onychomadesis following frostbite in a serving soldier posted at high altitude and extreme cold climate area.

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