An Evaluation of Platelet Factor 4, Beta-Thromboglobulin and Mean Platelet Volume in the Assessment of Thrombotic Risks in Subjects with Diabetes Mellitus at Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

BACKGROUND: Beta-thromboglobulin and platelet factor 4 are known platelet-specific proteins that are stored in the platelet alpha-granules and released during platelet activation. The measurement of these proteins can reflect the degree of platelet activation and indirectly suggest a pro-thrombotic state. This study aimed at determining serum levels of Betathromboglobulin, mean platelet volume, and platelet factor 4 in diabetes mellitus and control subjects in Lagos, Nigeria. MATERIALS AND METHODS: Using enzyme-linked immunosorbent assay at Lagos State University Teaching Hospital, Ikeja, this study evaluated serum concentrations of Beta-thromboglobulin, and platelet factor 4, the mean platelet volume was also determined from a Full Blood Count of all participants. Data were analyzed using Statistical Package for Social Sciences, Inc., Chicago, Ill; version 26.0. The continuous variables were given as mean ± standard deviation. The P-value was considered to be statistically significant when ≤0.05. RESULTS: Beta-thromboglobulin concentration was higher and statistically significant (7.82 ± 1.54ng/ml and 6.70 ± 2.23 ng/ml; P = 0.01), platelet factor 4 (39.86 ± 11.25 ng/ml and 47.73 ± 21.73ng/ml, P = 0.06) and mean platelet volume (10.26± 1.06fl and 10.29 ± 1.02fl P = 0.89) were not statistically significant in the diabetes mellitus group compared with non-diabetic participants, platelet factor 4 was higher in the older than younger diabetes mellitus participants. CONCLUSION: Elevated Beta-thromboglobulin may suggest a possible increase in thrombotic risks among diabetes mellitus.

CONTEXTE: La bêta-thromboglobuline et le facteur plaquettaire 4 sont des protéines spécifiques des plaquettes qui sont stockées dans les alpha-granules plaquettaires et libérées lors de l'activation des plaquettes. La mesure de ces protéines peut refléter le degré d'activation des plaquettes et suggérer indirectement un état prothrombotique. Cette étude visait à déterminer les taux sériques de bêta-thromboglobuline, le volume plaquettaire moyen et le facteur plaquettaire 4 chez des sujets atteints de diabète sucré et des sujets témoins à Lagos, au Nigéria. MATÉRIEL ET MÉTHODES: En utilisant le dosage immunoenzymatique au Lagos State University Teaching Hospital, Ikeja, cette étude a évalué les concentrations sériques de bêtathromboglobuline et de facteur plaquettaire 4, le volume plaquettaire moyen a également été déterminé à partir d'une numération globulaire complète de tous les participants. Les données ont été analysées à l'aide du logiciel Statistical Package for Social Sciences, Inc, Chicago,Ill ; version 26.0. Les variables continues ont été exprimées en moyen ± écart-type. La valeur P a été considérée comme statistiquement significative lorsqu'elle était inférieure à ≤0,05. RÉSULTATS: La concentration de bêta-thromboglobuline était plus élevée et statistiquement significative (7,82±1,54ng/ml et 6,70±2,23 ng/ml ; P=0,01), le facteur plaquettaire 4 (39,86±11,25 ng/ml et 47,73±21,73 ng/ml, P=0,06) et le volume plaquettaire moyen (10. 26± 1.06fl et 10.29±1.02fl P= 0.89) n'étaient pas statistiquement significatifs dans le groupe diabète sucré par rapport aux participants non-diabétiques, le facteur plaquettaire 4 était plus élevé chez les participants diabétiques plus âgés que chez les plus jeunes. CONCLUSION: Un taux élevé de bêta-thromboglobuline peutsuggérer une augmentation possible des risques thrombotiques chez les personnes atteintes de diabète sucré. Mots-clés: Bêta-thromboglobuline, facteur plaquettaire 4, volume plaquettaire moyen.

Building a responsive healthcare system - A Nigerian experience.

Background: A healthcare system must be responsive to the needs of its clients, and this entails elements such as dignity, confidentiality, autonomy, prompt attention, social support, basic amenities, and choice of provider. This is targeted toward improvement and maintenance of the quality of healthcare with consequent improvement in patient outcomes at a reduced cost. Aim: The aim of this study is to articulate the approach that was adopted by the Federal Medical Centre, Ebute-Metta, Lagos, Nigeria, to confront some of the challenges faced by the health sector in Nigeria and make recommendations for the future. Materials and Methods: To identify and solve the problems mitigating quality service delivery in the hospital over an initial 18-month period, the management deployed the following tools: (i) mystery shopping; (ii) patient experience survey; and (iii) quality improvement using the SafeCare methodology. Results: The diagnosis identified the following problems: (i) service failure; (ii) financial and material leakages; (iii) challenges of human resources - poor attitude, indiscipline, inadequacy, and poor understanding of roles; (iv) infrastructural deficit and dilapidation; and (v) absence of technological support. The baseline quality assessment conducted with the SafeCare Standards gave a score of 45%, while performance at the follow-up quality assessment was 69%. Conclusion: As a direct result of the findings, the hospital designed an 18-month renewable strategic plan premised on five pillars: (i) human resources development; (ii) improvement of quality of service; (iii) expansion of services and infrastructure renewals; (iv) financial re-engineering and partnership; and (v) appropriate utilization of technology. Through this policy redirection and constant re-evaluation, our quality improvement journey continues to yield desired positive health system outcomes. We recommend collaborative quality improvement initiatives with strong internal political will that can harness both the institution's resources and independent experts on health system development.

Subclinical hypothyroidism in children with idiopathic childhood nephrotic syndrome at a tertiary institution in South-West Nigeria.

Background: Hypothyroidism in children with nephrotic syndrome (NS) is often attributed to prolonged loss of thyroxine binding globulin and thyroid hormones alongside protein in the urine. It has been historically associated with steroid-resistant NS alone. However, recent evidence supports the fact that subclinical hypothyroidism (SCH) does occur even in children with steroid responsive NS. Complications such as weight gain, hypercholesterolemia, delayed growth, delayed puberty, and depression could result from hypothyroidism and be erroneously attributed to NS, or the effect of steroid used in treatment. Incidentally salt intake, the major form of dietary iodine is often restricted in children with NS, possibly exacerbating any underlying hypothyroid state. Aim: The study aimed to determine the burden of SCH among our cohort of NS patients. Patients and Methods: A comparative cross-sectional study was designed to assess SCH [defined by high TSH (>6.0 mU/L and normal free T4 (0.8-2.0 ng/dl)] in hundred children with NS aged between one and fifteen years compared with hundred age and gender matched comparison group without NS. Blood and urine samples were collected to analyze thyroid function, serum albumin, serum protein and urinary protein. Results: The prevalence of SCH was significantly higher in subjects with NS than their age, sex matched comparison group (12% vs. 2%, P = 0.006). The highest proportion (24.1%) of the children with NS who had SCH was found in the age range of 11-15 years and majority were females (19.4% vs. 7.8%, respectively, P = 0.086). The proportion of children with SCH were higher in those with steroid-resistant NS than those responsive to steroids (26.3% vs. 8.6% P = 0.033). The average values of serum albumin and protein were also significantly lower in children with SCH than those without (2.91 mg/dl ± 0.8 vs. 3.78 mg/dl ± 0.9 and 3.99 mg/dl ± 1.3 vs. 5.02 mg/dl ± 1.3, respectively, P < 0.005). Also, the average value of urinary protein was significantly higher in those with SCH than those without [94.29 mg/dl (42.3-101.0) vs. 69.19 mg/dL (31.2-108.2), respectively, P = 0.023]. Participants with steroid-resistant NS have almost three-folds odd of developing SCH compared to steroid sensitive subjects (AOR 2.901; 95% CI 1.831-4.012; P = 0.038). Conclusion: Screening of children for SCH with NS especially steroid-resistant NS and frequent relapsing steroid sensitive NS for hypothyroidism before complications arise is pertinent to their holistic management. This becomes even more imperative in our environment as iodine deficiency hypothyroidism is still prevalent in some parts of the country.

Profile of insulin resistance of pregnant women at late third trimester in Nigeria: A descriptive cross-sectional report.

Background: Exaggerated level of insulin resistance (IR) is associated with poor pregnancy outcomes. Identifying affected women may forestall these outcomes. There are few reports on IR and its predictors among pregnant women in Nigeria. Aim: To determine the profile of IR, using the homeostatic model assessment of insulin resistance (HOMA-IR), and its predictors among parturient Nigerian women in third trimester. Patients and Methods: A cross-sectional baseline data of healthy pregnant women in third trimester, consecutively recruited into a cohort study that evaluated IR and neonatal outcomes at a tertiary maternity. Sociodemographic and clinical data were obtained. Fasting venous blood was analyzed for glucose and insulin and HOMA-IR was calculated. Results: We consecutively recruited 401 healthy pregnant women between 28 and 41 weeks [means ± SD = 37.4 ± 0.8 weeks]; mean age 31.52 ± 4.3 years (range: 20-41 years). Median (IQR) HOMA-IR was 1.15 (0.63, 1.96; range: 0.02-11.73). Binary multivariable logistic regression showed overweight- [aOR (95% CI) = 3.29 (1.18, 9.13)], hyperglycemia- [aOR (95% CI) = 2.98 (1.19, 6.90)], and hypertension as independent predictors of IR [aOR (95% CI) = 2.85 (1.18, 6.90)]. Conclusion: Among nondiabetic Nigerian pregnant women in late third trimester, IR was independently associated with overweight, hypertension, and hyperglycemia. Control of adiposity is a potential target for control of IR and consequently its outcomes.

The first report of bean common mosaic virus (BCMV) infection of African yam bean (Sphenostylis stenocarpa) in Nigeria.

BACKGROUND: African yam bean (Sphenostylis stenocarpa) is an underutilized crop that has the potential to contribute to sustainable food security. In October 2021, more than 90% African Yam Bean (AYB) plants showed typical virus symptoms of mosaic and necrosis in the grain legumes field of the Institute of Agricultural Research and Training (IAR&T), Nigeria. METHODS AND RESULTS: Subsequently, leaf samples were collected and tested by ELISA and PCR to identify the virus species. Anti-BCMV and anti-potyvirus antibodies both gave positive results when symptomatic leaves were tested, and PCR using primers designed to the coat protein gene of BCMV amplified a band of the expected size (469 bp). The sequence of the PCR product was deposited in GenBank with the accession No. OL763314. The nucleotide sequence of the coat protein gene had 99% identity with BCMV isolate TN2 (KY044818). The identities of the nucleotide and amino acid sequence of the partial CP gene of the isolated virus relative to those of other potyviruses were 82.96-99.12% and 87.33-100%,, respectively. Phylogenetic analyses of the partial CP-nucleotide sequences grouped the isolate from this study (BCMV-IART-AYB) and BCMV-TN2 in the same cluster with other BCMV strains of the peanut stripe (PSt) and the blackeye cowpea (BlC) strains. CONCLUSIONS: In this study, we identified Bean commom mosaic virus (BCMV) infecting AYB for the first time in Nigeria and show that it has high nucleotide and amino acid identity with an Isolate of cowpea-infecting BCMV in India and China respectively than isolate in Nigeria.

The prevalence of metabolic syndrome and its components among overweight and obese Nigerian adolescents and young adults.

BACKGROUND: The incidence of metabolic syndrome (MetS), is rapidly increasing in developing countries. However, the epidemiology of MetS is not well reported in the pediatric and young adult population. We determined the prevalence of MetS and its components among overweight and obese Nigerian adolescents and young adults presenting for university admission. MATERIALS AND METHODS: A cross-sectional study of overweight and obese adolescents and young adults was performed. Blood pressure readings were taken while participants were seated. Anthropometric measures of waist circumference, weight and height were also taken using standard protocols and the body mass index was computed thereafter. Venous blood for fasting plasma glucose, triglycerides and high density lipoprotein cholesterol was collected and assayed using standard laboratory methods. Metabolic syndrome was defined by the International Diabetes Federation criteria. Statistical significance was set at 0.05. RESULTS: 91 individuals (18 males) aged 18.1 ± 4.85 years were studied. 13 (14.3%) of them had MetS and 11 (84.6%) of these were adolescents. Abdominal obesity was prevalent in 89 (97.8%) participants, hypertension was prevalent in 39 (42.9%) participants and hyperglycaemia was prevalent in 5 (5.5%) participants. Hypertriglyceridaemia was least prevalent in one (1.1%) participant who did not have MetS. All the participants who had hyperglycaemia (5.5%) had MetS. CONCLUSIONS: There is a high prevalence of MetS in obese and overweight Nigerian adolescents and young adults with the clustering of two components in half of the population. These findings have profound implications hence there is an urgent need to institute primary and secondary interventions in this population.

Screening Nuclear Field Fluctuations in Quantum Dots for Indistinguishable Photon Generation.

A semiconductor quantum dot can generate highly coherent and indistinguishable single photons. However, intrinsic semiconductor dephasing mechanisms can reduce the visibility of two-photon interference. For an electron in a quantum dot, a fundamental dephasing process is the hyperfine interaction with the nuclear spin bath. Here, we directly probe the consequence of the fluctuating nuclear spins on the elastic and inelastic scattered photon spectra from a resident electron in a single dot. We find the in-plane component of the nuclear Overhauser field leads to detuned Raman scattered photons, broadened over experimental time scales by field fluctuations, which are distinguishable from both the elastic and incoherent components of the resonance fluorescence. This significantly reduces two-photon interference visibility. However, we demonstrate successful screening of the nuclear spin noise, which enables the generation of coherent single photons that exhibit high visibility two-photon interference.

Clinical profile, knowledge, and beliefs about diabetes among patients attending a Tertiary Health Centre in Lagos: A cross-sectional survey.

INTRODUCTION: Diabetes affects 347 million people worldwide; more than 80% of the affected live in low- or middle-income countries. Patients' beliefs about their medical conditions are important in helping physician focus on beliefs that needed to be changed or reinforced. The overall aim of this study was to improve the standard of care of patients with diabetes. METHODS: The study designed was a cross-sectional survey; adults with diabetes attending diabetic clinic of LASUTH took part in the survey. Participants were asked to fill a structured questionnaire which was used to assess clinical patterns, beliefs, and practice about diabetes. RESULTS: One hundred and fifty patients with diabetes took part in the study. This study showed that more females presented with diabetes compared with males, type 2 diabetes is commonerthan type 1 and there is a highassociation of the disease with hypertension or being overweight. More than half of the participants do not know the cause of diabetes, 13% believed that disease is curable, and 30% admitted to use alternative medications in addition to the anti-diabetic medications prescribed by the physicians. CONCLUSION: Knowing patients' beliefs and knowledge about diabetes is important to impart overall care for them. Health education about a disease should be planned to address beliefs and knowledge of patients about their medical condition to address misinformation and misconceptions about their disease conditions.

Motivational factors and future plans of nigerian orthodontic residents.

This study was conducted to investigate factors influencing career choice of Nigerian orthodontic residents and to identify their future plans. All orthodontic residents in the Nigerian residency training programs were invited to complete a survey in July 2010. Data were categorized by demographic variables and were analyzed with statistical methods including chi-square analyses. Twenty-eight of the thirty-seven orthodontic residents in Nigeria completed the survey. The most important factor influencing the decision to pursue specialty training in orthodontics was a "passion for orthodontics" (42.9 percent), followed by "intellectual stimulation/challenge" (25 percent). The decision to become an orthodontist was made by 32.1 percent of the respondents while in dental school; 35.7 percent decided after completing dental school during private practice and 14.3 percent during a dental residency, while 3.6 percent had already decided before starting their dental school studies. Eleven residents (39.3 percent) said they plan to work in a private practice environment. Only four residents indicated that they will most likely practice primarily in an academic setting, while ten were undecided. Most residents (85.7 percent) reported planning to practice in an urban setting. A passion for orthodontics was the major attraction for orthodontic residency training for most residents in Nigeria, and few residents were considering academic career choices after graduation.

Functional haemodynamic monitoring: The value of SVV as measured by the LiDCORapid™ in predicting fluid responsiveness in high risk vascular surgical patients.

BACKGROUND: There is growing evidence that optimal peri-operative fluid management in high-risk surgical patients improves their post-operative outcome. Functional haemodynamic parameters such as SVV (stroke volume variation), PPV (pulse pressure variation) and SPV (systolic pressure variation) have been shown to be superior to CVP (central venous pressure) and ΔCVP in predicting fluid responsiveness. The aim of this study was to determine the accuracy and threshold values of these dynamic parameters using the minimally invasive LiDCORapid™ in high-risk surgical patients. METHODS: Fluid therapy in 70 patients undergoing vascular surgery was based on parameters derived from the LiDCORapid™. All patients received TIVA (total intravenous anaesthesia) and were ventilated with ≥7 ml/kg tidal volume. Haemodynamic data before and after fluid boluses were recorded and analyzed retrospectively. ΔSVI (stroke volume index) ≥10% was determined to be a positive response to a fluid challenge. The AUROCs (area under the receiver-operator curves) and confidence intervals thereof were used to assess the ability of each parameter to predict fluid responsiveness. RESULTS: 32/43 fluid challenges were positive (74.4%). The correlation coefficients between baseline SVV, PPV, and SPV with ΔSVI were: 0.27 (p = 0.08), 0.18 (p = 0.25) and -0.01 (p = 0.96) whilst the AUROCs were 0.75 (0.57-0.93), 0.67 (0.48-0.85) and 0.58 (0.35-0.81) respectively. The best cut-off for SVV using Youden's index was 13.5%, with J = 0.48. At this level, the LR+ (positive likelihood ratio) = 2.74, LR- (negative likelihood ratio) = 0.34 and the DOR (diagnostic odds ratio) = 8.06. CONCLUSION: Only the SVV was an adequate predictor of fluid responsiveness in this cohort of high risk surgical patients. Whereas PPV and SPV may be obtained from the arterial trace, estimation of the SVV requires a cardiac output monitor which is able to convert an arterial pressure trace into an estimation of stroke volume.

Cocoa powder extracts exhibits hypolipidemic potential in cholesterol-fed rats.

INTRODUCTION: Hypercholesterolemia and oxidative stress are risk factors of cardiovascular diseases. OBJECTIVES: This study investigated the hypolipidemic effect of cocoa powder extract (CPE) in an experimental model of hypercholesterolemia, using Questran as a reference. METHODS: Hypercholesterolemia in rats was induced by oral administration of 30 mg/kg cholesterol for eight weeks. Three groups concurrently received Questran (0.26 g/kgb) and CPE (100 mg/kg and 200 mg/kg) respectively. Hypercholesterolemia and dyslipidemia were assessed by lipid profile. Reduced glutathione (GSH), Superoxide dismutase (SOD), Catalase (CAT), Glutathione-S-transferase (GST) and malondialdehyde (MDA) level were also assessed to evaluate the antioxidant status of rats. RESULTS: There was 56% and 97% increase in total and LDL-cholesterol and 59% decrease in HDL-cholesterol levels on cholesterol administration. Concurrent administration of CPE (100 mg/kg) significantly (p < 0.05) decreased total cholesterol (19%) and LDL-cholesterol (22%) and increased HDL-cholesterol (286%) levels while at 200 mg/kg, 55% and 64% reductions in total and LDL-cholesterol and 250% increase in HDL-cholesterol levels were observed. No significant changes were observed in phospholipid levels. Body weights of rats were not significantly different among groups and CPE (100 mg/kg) ameliorated the cholesterol-induced enlargement of the liver and heart by 14% and 15% respectively and at 200 mg/kg by 21% in the heart. GSH and CAT were significantly depleted, and MDA and SOD significantly elevated in liver and heart of Cholesterol-fed rats. No significant changes in GST, alanine and aspartate aminotransferases occurred among groups. CPE treatment modulated these changes. CONCLUSION: Cocoa powder possesses hypolipidemic potential and may be relevant in treating pathologies with dyslipidemia as an underlying cause.

Review of the practice of traditional bone setting in Nigeria.

BACKGROUND: The practice of traditional bone setting (TBS) is extensive in Nigeria and it enjoys enormous patronage by the populace. However, the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient. There are many publications highlighting different aspects of this subject but none has summarized the entire practice and problems as a single publication. OBJECTIVE: This work aims at reviewing the entire subject of traditional bone setting in Nigeria in a single article to enable easy understanding and appreciation of the practice and problems of traditional bone setting by orthodox practitioners. METHOD: A total of thirty-one relevant published original scientific research papers involving all aspects of the subject were reviewed and the practices and problems were documented. RESULTS: The results showed that the origin of the practice is shrouded in mystery but passed on by practitioners from one generation to another. There is no formal training of bonesetters. Though the methods of treatment vary, the problems caused by them are usually similar with extremity gangrene being the worst. When attempts have been made to train the bone setters, improvement have been noted in their performance. CONCLUSION: In other to prevent some of the most debilitating outcomes like amputation, it is suggested that the TBS practitioners undergo some training from orthopaedic practitioners.

Analyses of air samples for ascospores of Leptosphaeria maculans and L.biglobosa by light microscopy and molecular techniques.

Spores of many fungal pathogens are dispersed by wind. Detection of these airborne inocula is important in forecasting both the onset and the risk of epiphytotics. Species-specific primers targeted at the internal transcribed spacer (ITS) region of Leptosphaeria maculans and L. biglobosa - the causal organisms of phoma stem canker and stem lesions of Brassica spp., including oilseed rape - were used to detect DNA extracted from particles deposited on tapes obtained from a spore trap operated in Rarwino (northwest Poland) from September to November in 2004 and 2006. The quantities of DNA assessed by traditional end-point PCR and quantitative real-time PCR were compared to microscopic counts of airborne ascospores. Results of this study showed that fluctuations in timing of ascospore release corresponded to the dynamics of combined concentrations of DNA from L. maculans and L. biglobosa, with significant positive correlations between ascospore number and DNA yield. Thus the utilization of PCR-based molecular diagnostic techniques enabled the detection, identification, and accurate quantification of airborne inoculum at the species level. Moreover, real-time PCR was more sensitive than traditional PCR, especially in years with low ascospore numbers.

Complications of treatment of musculoskeletal injuries by bone setters.

BACKGROUND: Traditional bone setters (TBS) have existed for decades in Nigeria and other countries. Their treatment methods often lead to several complications, the most dangerous being extremity gangrene which usually leads to proximal amputation. OBJECTIVE: To apprise the Orthodox Practitioners of complications of musculoskeletal injuries treated by the bone setters, the factors that encourage patronage of TBS services and the outcome of the treatment of these complications by the orthodox practitioners. METHODS: This was a one-year prospective study involving one hundred and twenty-one consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. The following data were obtained using observer-administered questionnaires viz; demography, details of initial injury, reasons for patronage of TBS, nature of treatment, estimated cost of treatment and disability of patients at presentation. The outcome of orthodox treatment of these complications was assessed at six months using the following parameters --wound healing, bone union and use of prosthesis by the patients. RESULTS: One hundred and twenty-one patients with 155 musculoskeletal injuries and 168 complications of treatment by the TBS were seen 75 (57%) were male and 52 (43%) were female. The ages of the patients ranged from 6 weeks--72 years (mean 29.49 years). The common complications of TBS treatment were malunion and non-union which each accounted for 27 (16.1%) cases. The major reasons for TBS patronage was the perceived low cost of treatment in 47 (27.9%) and pressure from family and friends in 36 (25%) patients. The cost of treatment of the TBS ranged from USD 18-380, whereas, at the Orthopaedic Hospital, it ranged from USD 34-98. At six months after orthodox surgery, 10 (91%) of the patients who had amputation were yet to start using prosthesis, 3 (23%) who had internal fixation failed to unite. CONCLUSION: The commonest reason for patronage was the believed cheapness of the TBS services. However, this study showed that orthodox treatment is actually cheaper in most cases. Despite all the complications associated with their treatment, majority of the people still have a strong belief in their capability. A suggested solution will be the incorporation of the TBS into the healthcare system so that they could be better trained and controlled.

Audit of Echocardiographic Services at the University College Hospital Ibadan.

BACKGROUND: Echocardiography is useful in the diagnosis of cardiovascular diseases and it influences management. It is becoming widely available in our Teaching Hospitals though expensive. It is therefore important to know the value of echocardiography in patients' diagnosis. METHODS: One thousand five hundred and forty four patients referred for transthoracic echocardiography over 19-month period (March 2003 to September 2004) were studied. M mode, two dimensional and Doppler studies were out using ALOKA SSD 1700. RESULTS: One thousand five hundred and forty four patients (778 males and 766 females) had echocardiography. Mean age was 51.4 +/- 15.5. Minimal age was 15 years while maximum was 100 years. The commonest indication for echocardiography include Hypertension 727 (47.1%), Pre-Chemotherapy assessment 127 (8.2%), Heart failure 117 (7.6%) and Routine Medical Check Up 99 (6.4%). The highest source of referral came from Cardiology unit 746 (48.3%). Staff Clinic 128 (8.3%), Surgery 127 (8.2%) and Nephrology 88 (5.7%). Six hundred and eighty seven (44.6%) were diagnosed as Hypertensive Heart Disease, 674 (36.5%) were Normal Study and 54 (3.5%) had Valvular Heart Disease. CONCLUSION: The study showed the different indications for echocardiography, source of referral and diagnosis. There is an emerging need for echocardiography in our patients so as to improve their management.