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Introduction: Contact of health care workers and patient at health facility lead to the transmission of pathogenic organisms to each other. Hospital acquired infection prevention is standardized guide lines contain multitude protocols needed to be implemented by health care workers to reduce hospital acquired infections. Objective: To assess health care workers knowledge, attitude and practice towards hospital acquired infection prevention at Dessie referral hospital. Method: Institutional based cross sectional study was conducted among health care workers. The subjects were selected by proportional allocation in each respective department and simple random sampling method was employed. Statistical package for social sciences (SPSS) was used to analyze the data and presented in frequency tables and graph. Results: 191 study subjects were participated in the study which gives a response rate of 90.5% from 211 total sample sizes. The study subjects had given their response according to self-administered questioner. The result indicates that 86.4%, 76.4% and 77% of respondents had good knowledge and favorable attitude and poor practice towards hospital acquired infection prevention respectively. Conclusion: Even though the majority of the health care workers had good knowledge and favorable attitude, more than two third of them had poor practice towards hospital acquired infection prevention. Therefore health workers should strictly follow hospital acquired infection prevention guidelines. Improving sustainable supplies like personal protective equipment, water supply and hand washing facilities at patient care site is vital to correct the poor practice of infection prevention.

From the energy involved in a physical or chemical process, part of it cannot be utilised as work. Entropy S is the thermodynamic quantity that is the measure of this energy where the concept of entropy was first introduced by Rudolf Clausius (1822-1888) in 1865. Entropy is also a basic and general conception that deals with “order” (low entropy) and “disorder” (high entropy) of all systems in the universe from human body and up to the star systems. With the development of science entropy deviates from treatment of subjects related to heat and work and currently it is used also to analyse knowledge as well as in economics. 

Background: Communication is the process of exchanging information or messages from one group to the other through mutually understood verbal or non-verbal ways. Communication barrier is anything that prevents receiving and understanding the messages. poor communication between patients and the nurses’ result in an increased length of stay, wastage of the resource, patient dissatisfaction, absence of confidence, and frustration for both the nurses and the patients. This study will provide basic information on the level of nurses to patients’ communication and perceived barriers in government hospitals of Bahir Dar city. Objective: The objective of this study was to assess the level of the nurse to patient communication and perceived barriers in government hospital of Bahir Dar city, Ethiopia, 2020. Methods: Institution based cross-sectional mixed-methods study was conducted from February 24 – March 9/2020 in government hospitals of Bahir Dar city. A total of 380 nurses were included in the quantitative study by using simple random sampling. For both the quantitative and qualitative study, at the initial stage of data collection and interview; informed consent was obtained from respondents. Data were entered into Epi Data 4.6 and analyzed with a statistical package of social science version 25. Data were mainly analyzed using descriptive statistics and binary logistic regression. For the qualitative study, purposive sampling technique was employed, and 7 participants were interviewed. Thematic analysis was used. Results: From the total participants 36.5% of nurses were found to have poor communication. Variables which have statistically significant associations with the level of communication were educational level, work experience, the unwillingness of nurses, and lack of communication skill. The highest perceived communication barriers were lack of continuous training with 82.7% followed by workload with 80.7% and lack of medical facilities with 79.2% as reported by nurses. All environmental-related barriers were the perceived barriers of the nurse to patient communication. Conclusion: In this study, the communication of nurses to patients is found to low. To enhance communication with the patients; nurses and other stakeholders like the ministry of health, the health bureau, and hospital authorities need to recognize the communication barriers. Giving awareness on the communication barrier for the nurses helps to minimize the barriers and improve the nurses to patients’ communication.

Oguta LGA is surrounded by 44 oil wells located around different communities. Preliminary investigations indicated that crude wastes were not properly managed and oil spillage occurred regularly in the LGA. Therefore, assessment of both radionuclide contents in yam matrix and health risks in Oguta was carried out to determine possible radiological health risks associated with improper management of crude wastes, and also evaluate haematological health profile in the LGA for future reference and research. A well calibrated NaI (Tl) detector was deployed for the radiological investigation, and about 5 ml of blood samples were collected from 190 participants each from Oguta and the control LGAs for haematological assessment. Mean activity concentrations due to 40K, 226Ra and 232Th in yam samples from Oguta LGA were 189.99 ± 59.14 Bqkg-1, 23.75 ± 5.69 Bqkg-1 and 30.99 ± 9.51 Bqkg-1, respectively while mean activity concentrations due to natural radionuclides in yam samples from control LGA were 110.40 ± 78.53 Bqkg-1, 10.12 ± 3.34 Bqkg-1 and 18.39 ± 8.74 Bqkg-1 for 40K, 226Ra and 232Th, respectively. Committed effective dose equivalent values in Oguta and the control LGAs were 704.95 ± 183.30 μSvy-1 and 403.65 ± 172.19 μSvy-1, respectively which are less than world average value of 1.1 mSvy-1. Crucially, one-way ANOVA at α0.05 has indicated that effects of radiological parameters due to natural radionuclides in yam from Oguta are significantly different from effects of radiological parameters due to natural radionuclides in yam from the control LGA. However, the percentage contributions of natural radiation exposures to incidence of cancer in Oguta and the control LGAs are just 1.7% and 1.4%, respectively, and haematological investigations have shown that overall health of the communities in the study LGAs has not been compromised due to environmental and human factors. Hence, natural radioactivity may have been elevated in Oguta but the concentration levels are not yet alarming. Radiological health risks could result from consistent exposure to those natural radionuclides in the long term.

Objective: The FITT (Frequency, Intensity, Time, and Type) principle is an effective foundation in EP. However, the CORRECT components; C–Combination of interventions, O–Order of the Interventions, R–Repetitions, R–Rest period between sets and between sessions, E–Exercise at home, C–Cognitive domain, T–Total dose and re-evaluation plans, should be considered. The purpose of this paper was to describe the updated dynamic and evidence based FITT-CORRECT principle of EP and demonstrates its application using a case study. Results: Literatures, related to EP, clinical reasoning and clinical decision-making, were critically reviewed. Established evidence is summarized to describe an updated dynamic and evidence-based principle of EP. The gaps within the FITT and other related principles of EP are addressed. The FITT-CORRECT principle was introduced and an effective outcome of the updated principle was demonstrated using a case study. The FITT-CORRECT principle integrates many components that are missing in the FITT and other related EP principles. Based on the reported case study, the FITT-CORRECT principle of EP should optimize patients’ intervention outcomes. Physiotherapists can potentially improve their EP by utilizing the FITT-CORRECT in clinical practice.

Background: Post exposure chemoprophylaxis can prevent human immunodeficiency virus (HIV) infection in risk healthcare workers; however routine adoptions of these practices by the workers have been limited. Objective: To assess knowledge and attitude of health workers on HIV post-exposure prophylaxis and exposure to sharp injuries in Dessie referral hospital. Methods: Across-sectional study was conducted on 422 health care workers of Dessie referral Hospital. The study subjects were selected by proportional allocation of each sample in its respective department/ward. Simple random sampling method was used to select study participants. The data was cleaned coded and analyzed by using statistical package for social sciences (SPSS) version 23. Finally the result was presented by graphs, pie chart and statements. Results: A total of 422 study subjects were participated in the study. Among 422 participants 72.5% had good knowledge of post exposure prophylaxis for HIV and the rest 27.5% had poor knowledge of post exposure prophylaxis for HIV. Among 422 study participants 75.2% had positive attitude towards PEP. 283(67.1%) of them had exposure to sharp injuries. Conclusion: Generally most of health care workers had good knowledge about post exposure prophylaxis against HIV/AIDS. This study had shown that a significant number of individuals had a negative attitude with regard to post exposure prophylaxis. Therefore, formal training that aims to improve attitudes and support to improve PEP implementation and completion are needed. 

In this work the statistical and squeezing properties of light-driven by sub-harmonic generation with two-mode coherent light are studied. With interaction Hamiltonian of both two-mode coherent and sub harmonic generation, we have driven master equation of system under consideration. From the master equation, the solution of the C-number Langevin equation is derived. It helps us to solve quadrature variance, quadrature squeezing, mean, and variance of photon number for light produced by sub-harmonic generation with the two-mode coherent light state. And the result shows that; the squeezing occurs in plus quadrature with the maximum squeezing of 87%. The photon statistics of the system under consideration is subpoissonian in which both mean & variance are increasing as kappa increase.

In the research of steam turbine rotor, start-up optimization is a very key research problem. A series of start-up optimization research can greatly improve the start-up efficiency of steam turbine and the safety performance of the unit. The start-up optimization of steam turbine is inseparable from the analysis of the start-up process of steam turbine and the mathematical model of the startup process of steam turbine unit, because the optimization of steam turbine unit can be regarded as a function to find the optimal solution. This paper analyzes the start-up process of 300 MW steam turbine, analyzes the start-up process of steam turbine unit through the data used in the actual power plant, and gives the mathematical model of cold start-up of steam turbine according to the start-up process of steam turbine, so as to further study the start-up optimization of steam turbine. Finally, the optimization model is determined by several key parameters, which are three weight coefficients α1,α2,α3, the actual damage value Di and damage limit value Dlim, and the start-up time ti and total start-up time t0 of each stage.

Einstein’s special and general relativity revolutionized physics. The predictions of general relativity are Strong Lensing, Weak Lensing, Microlensing, Black Holes, Relativistic Jets, A Gravitational Vortex, Gravitational Waves, The Sun Delaying Radio Signals, Proof from Orbiting Earth, Expansion of the universe. The density of the universe determines the geometry and fate of the universe. According to Freedman’s equations of general relativity published in 1922 and 1924, the geometry of the universe may be closed, open and flat. It all depends upon the curvature of the universe also. Various results of Cosmic Microwave Background Radiation (CMBR), NASA’s Wilkinson Microwave Anisotropy Probe (WMAP), and ESA’s Planck spacecraft probes found that our universe is flat within a margin of 0.4% error. In this short work, by applying the laws of quadratic equations, we attempt to show that OUR UNIVERSE IS FLAT.

Lichen Planopilaris is known as the form of Lichen Planus typical of the scalp. It is classified as a lymphatic disease and is characterized by chronic inflammation which leads to cicatricial alopecia. Its causes are not yet well characterized but its etiology seems to strongly correlates with infection, sensitization and pollution. A clear and objective diagnosis of Lichen Planopilaris is not simple but the evolution and strongly negative outcomes on scalp of people affected by, pose the need of an early diagnosis. In this work we report the case of a 27-year-old male and a 54-year-old female, respectively, in which a correct diagnosis of Lichen Planopilaris, followed the incorrect previous ones, was made by means of dermatoscopy and histopathological analysis, decisive tools for the diagnosis of this kind of pathology.

Background: Diabetes mellitus is a common health problem in the world and Africa including Ethiopia. Its complication is the major cause of morbidity and mortality of people due to improper self-care practice. Objective: To assess self-care practices and associated factors among type 2 adult diabetic patients on follow-up clinic of Dessie referral hospital, Ethiopia. Method: Institutional based cross sectional study was conducted. Total of 278 type 2 diabetic patients was selected by systematic random sampling technique and data was collected by interviewer administered pretested questionnaire. Epidata 3.1 and SPSS version 23 software were used for data entry and analysis, respectively. In bivariate analysis, variables having a p - value of < 0.2 were entered to multivariate analysis model and statistical significance was declared at p - value of < 0.05 and 95% confidence interval. Results: The response rate was 269 (96.76%) of the total 278 participants. Among the respondents 150(55.8%) had good diabetic self-care practice. This study showed that primary school education level (AOR=2.592, 95%CI=1.104-6.087, p = 0.029), secondary school education level (AOR=3.873, 95%CI=1.325-11.323, p = 0.013), college/university graduate (AOR=3.030, 95%CI=1.276-7.197, 0.012), attended diabetic education regularly (AOR=2.981, 95%CI=1.050-8.462, p = 0.040), member of diabetic association (AOR=3.496, 95%CI=1.440-8.483, p = 0.006) and having glucometer at home (AOR=2.634, 95%CI=1.357-5.111, p = 0.004) were significantly associated with diabetes self-care practice. Conclusion: Nearly half of diabetic patients had poor self care practice. Hence, there is a need to improve diabetic self-care practice. Attention should be given by policy makers, Dessie referral hospital, health care professionals, diabetic associations and researchers.

A thought-provoking debate in the popular literature concerning vaccination has blossomed in recent years [1-6]. While “traditionalists” support universal immunization against a variety of infectious diseases, many influential individuals hold that vaccinations do far more harm than good. The web sites vactruth.com and anhinternational.org are typical web sites to visit to understand their concerns.  More details on the debate, offering commentary on both sides of the issue, can be explored at wikipedia.org/wiki/Vaccine_controversies. In essence, however, those arguing for the universal use of vaccines point to the many millions of lives saved since mass immunization programs were introduced and further argue that resistance to routine vaccination is almost always based on false information. Those arguing against the routine use of vaccines usually either contend that the vaccines are unsafe (often maintaining that vaccine components such as formaldehyde or thimerosal are highly toxic) or alternately argue that governments simply do not have the moral authority to encroach on an individual’s freedom to make medical decisions for themselves or for their children.

Background: Tetanus continues to threaten the survival of children in spite of it being a vaccine preventable disease. The objective of this study was to determine the prevalence of post-neonatal tetanus, review the vaccination of affected children, complications encountered and the outcome among affected children in a tertiary health institution in southwestern Nigeria. Methods: The study was a retrospective study. Case notes of children outside neonatal life admitted to the Paediatric ward with clinical diagnosis of tetanus between January 2012 and October 2018 were retrieved and evaluated to identify socio-demographic and clinical characteristics. A review of the immunization history and cards was done where the immunization cards were available. Results: 21children with post-neonatal tetanus were admitted over a period of six years (November 2012 to October 2018) with a prevalence of 0.3%. The M:F was 3.2:1. The mean age in years was 10.14 ±3.44 while the age range of the subjects was 4 to 16years. None of the patients had booster doses of tetanus toxoid (TT) outside the infancy period. Nine (42.9%) subjects had no previous TT vaccination, 2 (9.5%) had 3 doses of TT vaccine in infancy but developed tetanus at age ≥9 years, 1(4.8%) subject had a dose of TT while the remaining 9subjects had no proof of previous TT vaccination. The percentage mortality was 19% (4 out of 21). All the patients that died had no prior record of TT vaccination. Complications identified included laryngeal spasm and autonomic dysfunction. Conclusion: Post-neonatal tetanus is still common in our locality because booster doses of Tetanus Toxoid are not part of the national immunization schedule. Complete dose of tetanus toxoid vaccination during infancy and booster doses at school entry is necessary and should be part of school health programme to forestall post-neonatal tetanus

Zinc induced pediatric preventing respiratory 2019-nCoV is required that supplementation with zinc gluconate 20 mg in Zn deficient children resulted in a nearly twofold reduction of acute lower respiratory infections as well as the time to recovery. Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia. Preventing 2019-nCoV pneumonia is required that zinc supplementation alone (10 to 20 mg) for more than 3 months significantly reduces in the rate of pneumonia. zinc pediatric intake may be required to be effective range 10～20 mg/d for 2019-CoV prevention, 10～30 mg/d for reduction of COVID-19 bronchitis, and 20～30 mg/d for recovery from COVID-19 pneumonia, in which Zn2+ could bind with viral surface proteins by Zn2+ions-centered tetrahedrally coordination pattern. On the other hand, for aults, the zinc-homeostatic immune concentration may provide a protective role against the COVID-19 pandemic, likely by improving the host’s resistance against viral infection. 50 mg of zinc per day might provide an additional shield against the COVID-19 pandemic, possibly by increasing the host resistance to viral infection to minimize the burden of the disease. In order to prevent that an outbreak of respiratory sickness caused by a novel coronavirus (COVID-19) has become a serious public threat and disrupted many lives,assessing the efficacy of FDA-approved Zn-ejector drugs such as disulfiram combined with interferon to treat COVID-19 infected patients has been proposed. The key strategies for preventing lung damages include avoiding direct lung infection, altering host-virus interactions, promoting immune responses, diluting virus concentrations in lung tissues by promoting viral migration to the rest of the body, maintaining waste removal balance, protecting heart function and renal function, avoiding other infections, reducing allergic reactions and anti-inflammatory. The interactions had been found on the binding specificity by Zn2+ ions-centered tetrahedral geometric coordination of the inhibitors against 3C and 3C-like proteases. In addition, transient zinc chelation TPEN and EPDTC have been noted as preventing virus replication. Zinc-induced ROS production in COVID-19 respiratory ailment and pneumonia occurs both in children and adults. In children. ROS production in zinc (Ⅱ)-immune pediatric patient with COVID-19 bronchitis and pneumonia cannot be elucidated yet. In adults, zinc induced ROS generation in pulmonary COVID-19 infected cells is that alterations of ROS-producing and scavenging pathways that are caused by respiratory viral infections are implicated in inflammation, lung epithelial disruption, and tissue damage, and, in some cases, even pulmonary fibrosis. The involvement of oxidative stress in cell deaths caused during RNA virus infection and ROS production is correlated with host cell death.

Introduction: Endothelial progenitor cells (EPC) are involved in vascular repair and proliferation, contributing to the long-term outcomes of apheretic treatment. Aim of this study was to investigate the relationships between endothelial function, assessed by levels of bone marrow-derived progenitor cells and endothelial response to hyperaemia, and clinical and biohumoral parameters in high vascular risk patients before, immediately after, 24-hours and 72 hours after a single lipid apheresis procedure. Material and Methods: We evaluated lipid profile, endothelial function and endothelial progenitor cells before (T0), immediately after (T1), 24h after (T2) and 72h after (T3) a lipoprotein apheresis procedure, in 8 consecutive patients [Sex: 62.5% M; Age; 63.29(12), mean, (range) years] with a personal history of acute coronary syndrome, symptomatic peripheral arterial disease and elevated plasma levels of lipoprotein (a) [Lp(a)]. Patients were on regularly weekly or biweekly lipoprotein apheresis, and they were treated with the FDA-approved Heparin-induced Extracorporeal LDL Precipitation (H.E.L.P.) (Plasmat Futura, B.Braun, Melsungen, Germany) technique. PAT values were expressed as the natural logarithm (Ln-RHI, normal values≥0.4) of the reactive hyperaemia index (RHI), which is the parameter automatically calculated by the device. Results: We found a reduction in the natural logarithm of reactive hyperaemia index (Ln-RHI), assessed immediately after the procedure (0.57±0.21 vs 0.72± 0.29); difference between T2 and T0 was statistically significant (0.43±0.24 vs 0.72±0.29; p=0.006). Reduction in Ln-RHI values was documented in all patients, two subjects showing a Ln-RHI<0.4 at T1, and four at T2. At T3, PAT values were increased significantly (0.91±0.18) in comparison to T1 and T2, showing a median value higher than at T0. Cd34+/Kdr+ and Cd133+/Kdr+ showed a minimum increase in median values at T1, and a higher increase at T2, in comparison to baseline. Differences in Cd34+/133+/Kdr+ values at different times were not statistically significant. A significant reduction in circulating endothelial cells (CEC) count at T2 in comparison to T0 was found (12.00±8.85 vs 23.86±12.39; p=0.024). Discussion: At 24h and 72h after procedures, we found an improvement in endothelial function, expressed by an increase in PAT values and EPC levels, and by a reduction in CEC.

Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature. Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications. Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available. Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms

58-year-old male patient who came to the dermatology service for a clinical picture consisting of generalized erythematous scaly and pruritic lesions of 2 years of evolution. The clinical judgments provided were: pityriasis versicolor, drop psoriasis, pityriasis rubra pilaris and secondary syphilis (without serology confirming this last hypothesis then). A biopsy of a lesion located on the right costal side was performed. The serology was negative in a second time.

Background: Congenital Vascular malformation relatively rare and extremely varied clinical presentations. The purpose of our study was to present our initial experience of embolization in a series of 26 patients with congenital vascular malformation to assess retrospectively the results and the complications of ethanol and coils embolization treatment of these patients. Methods: Retrospective trial, the study group consisted of 26 patients with congenital vascular malformations. Transcatheter arterial embolization by ethanol or coils were performed, Therapeutic outcomes were established by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up angiography. Results: Between November 2014 and March 2018, 26 consecutive patients (3 male, 23 female) at Alshifa Hospital - Cardiac Catheterization Center with congenital vascular malformations in the body and extremities underwent staged ethanol or coils embolization. The mean age of the patients was 25 years (age range, 6– 59 years). Ethanol embolization was administrated in 16 patients, coil embolization in 9 patients and graft stent in one patient. The side effect such as pain, pulsation, and bruit in most of the patients were obtained. The reduction of redness, swelling, and warmth was achieved in all of the patients, According to the angiographic findings, congenital vascular malformation were devascularized 100% in 12 patients, 50% to 99% in 11 patients, less than 50% in 3 patients. The most common complications were reversible skin necrosis. Conclusion: Transcatheter embolization by ethanol or coils has proved efficacious and safe in the treatment of congenital vascular malformation of the body and extremities but with acceptable risk of complications

Background: The plant Artemisia annua has been used in traditional Chinese medicine for many years. Rich in bioactive molecules, the A. annua plant is used to extract the anti-malaria compound artemisinin (< 1%), which results in most of the plant being unutilized. One byproduct of artemisinin extraction is artemisia naphtha (AN), which has yet to be studied extensively. Aims: Study the activity of a novel AN oil extract against microbes, pro-inflammatory cytokines, and dermatological endpoints that are key for eczema and acne pathogenesis to determine if an effective A. annua extract for these skin conditions can be developed. Methods: Gas chromatography-mass spectrometry was performed to determine the composition of AN oil. P. acnes, S. aureus, M. furfur, and C. albicans were cultured to determine minimal inhibitory concentration. in vitro studies utilizing keratinocytes and macrophages were treated with AN oil and gene expression measured by quantitative RT-PCR. A 13-subject clinical trial was performed with 1% AN oil Gel to assess its potential benefits for sensitive and acne prone skin. Results: AN oil upregulates filaggrin gene expression and possesses antimicrobial and anti-inflammatory activity inhibiting LPS, S. aureus and "Th2 induced" pro-inflammatory mediator release (IL-6, IL-8 and TSLP). Clinical assessment of 1% AN Gel shows it reduces acne blemishes and the appearance of redness. Conclusion: Previously an underutilized and unpurified byproduct, AN is now the source to develop the first topical AN oil for cosmetic use with an activity profile that suggests it is effective for those with sensitive and/or acne prone skin.

Dissecting aortic aneurysm with ST segment elevation, and pulmonary embolism with ST segment elevation are two of a number of clinical entities which can simulate ST segment elevation myocardial infarction. Objective: The purpose of this review is to analyse clinical features in anecdotal reports of 138 dissecting aortic aneurysm patients with STEMI-like presentation, and 102 pulmonary embolism patients with STEMI-like presentation in order to generate insights which might help to optimise triage of patients with STEMI-like clinical presentation. Methods: Reports were culled from a literature search covering the period January 2000 to March 2020 using Googlescholar, Pubmed, EMBASE and MEDLINE. Reports were included only if there was a specification of the location of ST segment elevation and an account of the clinical signs and symptoms. Search terms were “ST segment elevation”,”aortic dissection”, “pulmonary embolism”, “myocardial infarction”, and “paradoxical embolism”. Fisher’s exact test was utilised for two-sided comparison of proportions. Proportion was calculated for each group as the number of patients with that parameter relative to the total number of patients assessed for that parameter. Findings: There were 138 patients with aortic dissection, 91 of whom were either fast-tracked to coronary angiography (81 patients) or fast-tracked to thrombolytic treatment (10 patients). There were 47 patients managed with neither of those strategies. There were 102 patients with pulmonary embolism, 71 of whom were fast tracked to coronary angiography, and 31 who did not receive that evaluation. Compared with their dissecting aortic aneurysm counterparts, those dissecting aortic aneurysm patients initially managed by percutaneous coronary intervention or by thrombolysis were significantly (p = 0.0003) more likely to have presented with chest pain, and significantly (p = 0.018) less likely to have presented with breathlessness. The preferential fast-tracking to coronary angiography prevailed in spite of comparable prevalence of back pain in fast tracked and in non-fast tracked subjects. Use of transthoracic echocardiography was also comparable in the two subgroups of dissecting aortic aneurysm patients. Pulmonary embolism patients fast tracked to percutaneous coronary intervention were significantly (p = 0.0008) more likely to have presented with chest pain than their pulmonary embolism counterparts who were not fast-tracked. The prevalence of paradoxical embolism was also significantly (p = 0.0016) higher in fast-tracked patients than in counterparts not fast-tracked. Cardiac arrest was significantly (p = 0.0177) less prevalent in fast-tracked pulmonary embolism patients than in pulmonary embolism patients who were not fast-tracked. Preferential fast-tracking to coronary angiography prevailed in spite of the fact that prevalence of documented deep vein thrombosis was comparable in fast-tracked subjects and in subjects not fast-tracked. The prevalence of use of transthoracic echocardiography was also similar in fast-tracked pulmonary embolism patients vs counterparts not fast tracked. Overall, however, transthoracic echocardiography had been utilised significantly (p = 0.007) less frequently in dissecting aneurysm patients than in pulmonary embolism patients. Conclusion: Given the high prevalence of STEMI-like presentation in aortic dissection there is a need for greater use of point-of-care transthoracic echocardiography to mitigate risk of inappropriate percutaneous coronary intervention(which might delay implementation of aortic repair surgery) and inappropriate thrombolysis(which might precipitate hemorrhagic cardiac tamponade) (75) during triage of patients presenting with ST segment elevation simulating ST segment elevation myocardial infarction (STEMI). Furthermore, during triage of patients with STEMI-like clinical presentation, the combined use of point-of -care echocardiography and evaluation for deep vein thrombosis will facilitate the differentiation between acute myocardial infarction, STEMI-like aortic dissection, and STEMI-like pulmonary embolism. Among STEMI-like patients in whom DAA has been ruled out by point of care TTE, fast tracking to PCI might generate an opportunity to identify and treat paradoxical coronary artery embolism by thrombectomy. Thereby mitigating the mortality risk associated with coronary occlusion. Concurrent awareness of PE as the underlying cause of paradoxical embolism also generates an opportunity to relieve the clot burden in the pulmonary circulation, either by pulmonary embolectomy or by thrombolysis. Above all, frontline clinicians should have a greater awareness of the syndrome of STEMI-like presentation of aortic dissection and STEMI-like pulmonary embolism so as to mitigate the risk of inappropriate thrombolysis and inappropriate percutaneous coronary angiography which seems to prevail even in the presence of red flags such as back pain (for aortic dissection) and deep vein thrombosis(for pulmonary embolism).