twalib aliku | Gulu University (original) (raw)

Papers by twalib aliku

European Journal of Echocardiography, Jan 6, 2015

The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a ... more The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a standard portable echocardiography (STAND) machine. A recent study in a tertiary care centre demonstrated that they also had good sensitivity and specificity when modified for use with handheld echocardiography (HAND). Our study aimed to evaluate the performance of HAND for early RHD diagnosis in the setting of a large-scale field screening. Methods and results STAND was performed in 4773 children in Gulu, Uganda, with 10% randomly assigned to also undergo HAND. Additionally, any child with mitral or aortic regurgitation also underwent HAND. Studies were performed by experienced echocardiographers and blindly reviewed by cardiologists using 2012 WHF criteria, which were modified slightly for HANDdue to the lack of spectral Doppler capability. Paired echocardiograms were performed in 1420 children (mean age 10.8 and 53% female), resulting in 1234 children who were normal, 133 who met criteria for borderline RHD, 47 who met criteria for definite RHD, and 6 who had other diagnoses. HAND had good sensitivity and specificity for RHD detection (78.9 and 87.2%, respectively), but was most sensitive for definite RHD (97.9%). Inter-and intra-reviewer agreement ranged between 66-83 and 71.4-94.1%, respectively. Conclusions HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols.

African Health Sciences, Mar 12, 2014

Global heart, Jun 1, 2016

PLOS ONE, 2021

Introduction To address workforce shortages and expand access to care, we developed a telemedicin... more Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by ca...

International Archives of Cardiovascular Diseases, 2019

Frontiers in Cardiovascular Medicine

BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a ra... more BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a rare form of restrictive cardiomyopathy found in the tropics. EMF occurs mainly in two phenotypes; biventricular involvement and right ventricular (RV) form. Previously endemic in several countries, there are reports suggesting that the disease is on the decline.ObjectivesTo describe trends in annual incidence rates of newly diagnosed EMF cases at the Uganda Heart Institute (UHI).MethodsThis was a retrospective chart review of all newly diagnosed EMF cases at UHI from January 2007 to December 2020. Cases were divided into two groups A (2007–2013) and B (2014–2020).ResultsA total of 155 cases were diagnosed during the period (Group A, n = 124; Group B, n = 31). There were no significant differences between the two groups A and B regarding median age at diagnosis (14 vs. 12 years, p = 0.0940), gender (48.4% female vs. 35.5%, p = 0.1987), and EMF type (66.9% RV EMF vs. 71.0%, p = 0.6634), res...

Annals of Pediatric Cardiology, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

European Heart Journal, Oct 1, 2019

Global Heart, 2016

Introduction: Rheumatic heart disease (RHD) is highly prevalent in Aboriginal people in Australia... more Introduction: Rheumatic heart disease (RHD) is highly prevalent in Aboriginal people in Australia. Despite decades of research, the underlying genetic mechanisms for why RHD occurs are not well understood. This genetic study was conducted to better understand why some people are susceptible to RHD and others are not. Past controversy in Indigenous genetic research has raised ethical concerns about the collection, use and storage of genetic samples. An appropriately designed methodology with a focus on cultural and ethical processes for gaining informed consent for the collection and treatment of samples was therefore vital to guide the study. Objectives: This study; investigating the genetic association of RHD in Aboriginal communities in the Northern Territory of Australia sought to establish a range of consultative, culturally aligned and community guided mechanisms to support and ensure a robust and ethically sound approach to genetic research took place with participating Aboriginal communities. Methods: Before individuals were approached for samples, an extensive period of Aboriginal governance, community engagement and qualitative inquiry formed stage 1 of the study. Indigenous methodology was employed to conduct five focus groups with communities, called 'yarning circles'. Genetic and health literacy material was produced, informed by communities, to ensure consent for the collection, use and storage of samples was well informed and understood. A protocol for the long-term governance of samples was established. Results: This study demonstrates how preliminary efforts to address issues of relationship building and engagement assisted in developing community members' genetic literacy and ensured that members understood what they were consenting to when giving permission to informed consent in the context of genetic research. This was critical to clarifying researchers' responsibilities and obligations in relation to the future use of stored data and genetic samples for other research projects, and will more likely result in benefit sharing between community members and researchers. Conclusion: This study demonstrates that such sensitive research can be ethically and successfully conducted. It can inform a pathway for ongoing research in this field and contribute to the formation of guidelines for the conduct of genetic research with Aboriginal communities.

Frontiers in Cardiovascular Medicine

In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD... more In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing—whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a grad...

American journal of medical genetics. Part A, 2017

The cover image, by Paul Kruszka et al., is based on the Original Article Noonan Syndrome in Dive... more The cover image, by Paul Kruszka et al., is based on the Original Article Noonan Syndrome in Diverse Populations, DOI: 10.1002/ajmg.a.38362. Design Credit: Darryl Leja.

Global Heart, 2014

indications, it allows 30%-55% of patients to undergo a successful subsequent AVR (even if BAV is... more indications, it allows 30%-55% of patients to undergo a successful subsequent AVR (even if BAV is performed as an emergency). The medium and long term outcomes of stand-alone BAV remain poor if not treated with definitive AVR. Disclosure of Interest: None Declared PW085 Impact of pulmonary artery hypertension on immediate and long-term results of percutaneous mitral balloon commissurotomy: Our experience

Heart, Lung and Circulation, 2019

people from the same region [2]. The underlying causes leading to poorer health outcomes are comp... more people from the same region [2]. The underlying causes leading to poorer health outcomes are complex and varied, relating to post-colonialism dispossession as well as geographical and socioeconomic factors.

Circulation, 2015

Background: Poorly understood genetic susceptibility factors influence who develops acute rheumat... more Background: Poorly understood genetic susceptibility factors influence who develops acute rheumatic fever (ARF) and who develops the long-term complication, rheumatic heart disease (RHD). Risk of RHD in family members - and thus the need for screening of first degree relatives - once an index case has been identified, is not known. Methods: Sixty RHD positive children (30 borderline 30 definite RHD) and 67 age & gender matched controls were recruited from previous school-based echocardiographic screening. All first-degree relatives ≥ 5 years were invited for echocardiographic screening (2012 World Heart Federation Criteria). Absent family members were recorded with reason for absence including death. Continuous variables were compared using 2-tailed independent samples t-test, categorical variables by Fisher’s Exact Test, and relative risk was used to compare cases and controls. Results: A total of 454/733 (62%) family members were screened (106 mothers, 48 fathers & 300 siblings). ...

Circulation, 2014

Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography ... more Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography (SPE) reveals a high burden of rheumatic heart disease (RHD) in resource poor settings, but widespread screening is limited by cost and physician availability. Handheld echocardiography (HHE) may decrease costs, but WHF criteria are complicated for rapid field screening, particularly for non-physician screeners. Objective: To determine the best simplified screening strategy for RHD detection using HHE. Methods: HHE (GE Vscan) and SPE (GE Vivid q or i or Philips CX-50) were performed in 5 schools in Gulu, Uganda. Borderline or definite RHD cases were defined by 2012 WHF criteria on SPE images, by 2 experienced readers. HHE studies were reviewed by cardiologists blinded to SP results. As HHE lacks continuous wave Doppler, pansystolic mitral regurgitation (MR) was defined as MR on 2 consecutive frames. We evaluated single and combined HHE parameters to determine the simplified screening str...

Pathogens, 2022

Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from... more Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from the developed world, the disease remains endemic in many low- and middle-income countries (LMICs), with grim health and socioeconomic impacts. The neglect of RHD which persisted for a semi-centennial was further driven by competing infectious diseases, particularly the human immunodeficiency virus (HIV) pandemic. However, over the last two-decades, slowly at first but with building momentum, there has been a resurgence of interest in RF/RHD. In this narrative review, we present the advances that have been made in the RF/RHD continuum over the past two decades since the re-awakening of interest, with a more concise focus on the last decade’s achievements. Such primary advances include understanding the genetic predisposition to RHD, group A Streptococcus (GAS) vaccine development, and improved diagnostic strategies for GAS pharyngitis. Echocardiographic screening for RHD has been a major...

List of all available presentations given as part of the Inaugural <b>PROTEA</b> (&lt... more List of all available presentations given as part of the Inaugural <b>PROTEA</b> (<i>Partnerships for Children with Heart Disease in Africa</i>) Workshop hosted by the <b>Children's Heart Disease Research Unit </b>under the directorship of A/Prof Liesl Zuhlke and in conjunction with the <b>Paediatric Cardiology Service of the Western Cape (13 - 16 March 2019)</b>. <br>A first in Africa, this workshop combined four events: a research methods workshop, a basic echocardiography (echo) workshop, two days of advanced echo as well as a rheumatic heart disease research think-tank. 130 delegates from 19 different countries representing all six continents attended the event, making it truly global and giving attendees the opportunity to meet and network with experts in the fields of rheumatic and congenital heart disease.<br>The above table contains the following information and links:<br><i>Number</i>: Number ...

European Journal of Echocardiography, Jan 6, 2015

The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a ... more The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a standard portable echocardiography (STAND) machine. A recent study in a tertiary care centre demonstrated that they also had good sensitivity and specificity when modified for use with handheld echocardiography (HAND). Our study aimed to evaluate the performance of HAND for early RHD diagnosis in the setting of a large-scale field screening. Methods and results STAND was performed in 4773 children in Gulu, Uganda, with 10% randomly assigned to also undergo HAND. Additionally, any child with mitral or aortic regurgitation also underwent HAND. Studies were performed by experienced echocardiographers and blindly reviewed by cardiologists using 2012 WHF criteria, which were modified slightly for HANDdue to the lack of spectral Doppler capability. Paired echocardiograms were performed in 1420 children (mean age 10.8 and 53% female), resulting in 1234 children who were normal, 133 who met criteria for borderline RHD, 47 who met criteria for definite RHD, and 6 who had other diagnoses. HAND had good sensitivity and specificity for RHD detection (78.9 and 87.2%, respectively), but was most sensitive for definite RHD (97.9%). Inter-and intra-reviewer agreement ranged between 66-83 and 71.4-94.1%, respectively. Conclusions HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols.

African Health Sciences, Mar 12, 2014

Global heart, Jun 1, 2016

PLOS ONE, 2021

Introduction To address workforce shortages and expand access to care, we developed a telemedicin... more Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by ca...

International Archives of Cardiovascular Diseases, 2019

Frontiers in Cardiovascular Medicine

BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a ra... more BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a rare form of restrictive cardiomyopathy found in the tropics. EMF occurs mainly in two phenotypes; biventricular involvement and right ventricular (RV) form. Previously endemic in several countries, there are reports suggesting that the disease is on the decline.ObjectivesTo describe trends in annual incidence rates of newly diagnosed EMF cases at the Uganda Heart Institute (UHI).MethodsThis was a retrospective chart review of all newly diagnosed EMF cases at UHI from January 2007 to December 2020. Cases were divided into two groups A (2007–2013) and B (2014–2020).ResultsA total of 155 cases were diagnosed during the period (Group A, n = 124; Group B, n = 31). There were no significant differences between the two groups A and B regarding median age at diagnosis (14 vs. 12 years, p = 0.0940), gender (48.4% female vs. 35.5%, p = 0.1987), and EMF type (66.9% RV EMF vs. 71.0%, p = 0.6634), res...

Annals of Pediatric Cardiology, 2016

This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

European Heart Journal, Oct 1, 2019

Global Heart, 2016

Introduction: Rheumatic heart disease (RHD) is highly prevalent in Aboriginal people in Australia... more Introduction: Rheumatic heart disease (RHD) is highly prevalent in Aboriginal people in Australia. Despite decades of research, the underlying genetic mechanisms for why RHD occurs are not well understood. This genetic study was conducted to better understand why some people are susceptible to RHD and others are not. Past controversy in Indigenous genetic research has raised ethical concerns about the collection, use and storage of genetic samples. An appropriately designed methodology with a focus on cultural and ethical processes for gaining informed consent for the collection and treatment of samples was therefore vital to guide the study. Objectives: This study; investigating the genetic association of RHD in Aboriginal communities in the Northern Territory of Australia sought to establish a range of consultative, culturally aligned and community guided mechanisms to support and ensure a robust and ethically sound approach to genetic research took place with participating Aboriginal communities. Methods: Before individuals were approached for samples, an extensive period of Aboriginal governance, community engagement and qualitative inquiry formed stage 1 of the study. Indigenous methodology was employed to conduct five focus groups with communities, called 'yarning circles'. Genetic and health literacy material was produced, informed by communities, to ensure consent for the collection, use and storage of samples was well informed and understood. A protocol for the long-term governance of samples was established. Results: This study demonstrates how preliminary efforts to address issues of relationship building and engagement assisted in developing community members' genetic literacy and ensured that members understood what they were consenting to when giving permission to informed consent in the context of genetic research. This was critical to clarifying researchers' responsibilities and obligations in relation to the future use of stored data and genetic samples for other research projects, and will more likely result in benefit sharing between community members and researchers. Conclusion: This study demonstrates that such sensitive research can be ethically and successfully conducted. It can inform a pathway for ongoing research in this field and contribute to the formation of guidelines for the conduct of genetic research with Aboriginal communities.

Frontiers in Cardiovascular Medicine

In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD... more In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs—hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing—whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a grad...

American journal of medical genetics. Part A, 2017

The cover image, by Paul Kruszka et al., is based on the Original Article Noonan Syndrome in Dive... more The cover image, by Paul Kruszka et al., is based on the Original Article Noonan Syndrome in Diverse Populations, DOI: 10.1002/ajmg.a.38362. Design Credit: Darryl Leja.

Global Heart, 2014

indications, it allows 30%-55% of patients to undergo a successful subsequent AVR (even if BAV is... more indications, it allows 30%-55% of patients to undergo a successful subsequent AVR (even if BAV is performed as an emergency). The medium and long term outcomes of stand-alone BAV remain poor if not treated with definitive AVR. Disclosure of Interest: None Declared PW085 Impact of pulmonary artery hypertension on immediate and long-term results of percutaneous mitral balloon commissurotomy: Our experience

Heart, Lung and Circulation, 2019

people from the same region [2]. The underlying causes leading to poorer health outcomes are comp... more people from the same region [2]. The underlying causes leading to poorer health outcomes are complex and varied, relating to post-colonialism dispossession as well as geographical and socioeconomic factors.

Circulation, 2015

Background: Poorly understood genetic susceptibility factors influence who develops acute rheumat... more Background: Poorly understood genetic susceptibility factors influence who develops acute rheumatic fever (ARF) and who develops the long-term complication, rheumatic heart disease (RHD). Risk of RHD in family members - and thus the need for screening of first degree relatives - once an index case has been identified, is not known. Methods: Sixty RHD positive children (30 borderline 30 definite RHD) and 67 age & gender matched controls were recruited from previous school-based echocardiographic screening. All first-degree relatives ≥ 5 years were invited for echocardiographic screening (2012 World Heart Federation Criteria). Absent family members were recorded with reason for absence including death. Continuous variables were compared using 2-tailed independent samples t-test, categorical variables by Fisher’s Exact Test, and relative risk was used to compare cases and controls. Results: A total of 454/733 (62%) family members were screened (106 mothers, 48 fathers & 300 siblings). ...

Circulation, 2014

Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography ... more Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography (SPE) reveals a high burden of rheumatic heart disease (RHD) in resource poor settings, but widespread screening is limited by cost and physician availability. Handheld echocardiography (HHE) may decrease costs, but WHF criteria are complicated for rapid field screening, particularly for non-physician screeners. Objective: To determine the best simplified screening strategy for RHD detection using HHE. Methods: HHE (GE Vscan) and SPE (GE Vivid q or i or Philips CX-50) were performed in 5 schools in Gulu, Uganda. Borderline or definite RHD cases were defined by 2012 WHF criteria on SPE images, by 2 experienced readers. HHE studies were reviewed by cardiologists blinded to SP results. As HHE lacks continuous wave Doppler, pansystolic mitral regurgitation (MR) was defined as MR on 2 consecutive frames. We evaluated single and combined HHE parameters to determine the simplified screening str...

Pathogens, 2022

Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from... more Nearly a century after rheumatic fever (RF) and rheumatic heart disease (RHD) was eradicated from the developed world, the disease remains endemic in many low- and middle-income countries (LMICs), with grim health and socioeconomic impacts. The neglect of RHD which persisted for a semi-centennial was further driven by competing infectious diseases, particularly the human immunodeficiency virus (HIV) pandemic. However, over the last two-decades, slowly at first but with building momentum, there has been a resurgence of interest in RF/RHD. In this narrative review, we present the advances that have been made in the RF/RHD continuum over the past two decades since the re-awakening of interest, with a more concise focus on the last decade’s achievements. Such primary advances include understanding the genetic predisposition to RHD, group A Streptococcus (GAS) vaccine development, and improved diagnostic strategies for GAS pharyngitis. Echocardiographic screening for RHD has been a major...

List of all available presentations given as part of the Inaugural <b>PROTEA</b> (&lt... more List of all available presentations given as part of the Inaugural <b>PROTEA</b> (<i>Partnerships for Children with Heart Disease in Africa</i>) Workshop hosted by the <b>Children's Heart Disease Research Unit </b>under the directorship of A/Prof Liesl Zuhlke and in conjunction with the <b>Paediatric Cardiology Service of the Western Cape (13 - 16 March 2019)</b>. <br>A first in Africa, this workshop combined four events: a research methods workshop, a basic echocardiography (echo) workshop, two days of advanced echo as well as a rheumatic heart disease research think-tank. 130 delegates from 19 different countries representing all six continents attended the event, making it truly global and giving attendees the opportunity to meet and network with experts in the fields of rheumatic and congenital heart disease.<br>The above table contains the following information and links:<br><i>Number</i>: Number ...