Ashraf Elghul, MD

Educator and a General Internist. Marshall University. #meded #proudtobeGIM #MarshallU

[سمية هاشم المحلاوي @somayahashem]

لم يتفوق على المنشاوي إلا المنشاوي!
هكذا ارتضى ضمير الشيخ المنشاوي -رحمة الله عليه- أن يُعيدَ تسجيل أكثر من ثلث الختمة القديمة.

[JAMA @JAMA_current]

Med News: A major meta-analysis has found that digital media use, particularly social media, is consistently linked to worse youth mental health and development.

https://t.co/s9E2AF4wRm

[JAMA @JAMA_current]

How can volume overload be reliably excluded at the bedside?

📊 This Rational Clinical Examination evaluates the diagnostic accuracy of clinical examination, radiographic imaging, and laboratory testing in assessing volume overload in nonintubated patients.

https://t.co/NycBzCLjqS

[JAMA @JAMA_current]

📊 JAMA Clinical Guidelines Synopsis: The 2024 guideline from the @American_Heart and @ACCinTouch recommends continuing statins and β-blockers for patients undergoing noncardiac surgery.

https://t.co/xCp4eIx8Oy

[Earth Hippy 🌎🕊️💚 @hippyygoat]

Did you know two Palestinian Muslim families have been custodians of Jerusalem’s Church of the Holy Sepulchre for centuries?

Since the 7th century, one family opens and closes the church while the Joudeh family safeguards its keys—a 1,300-year tradition symbolising trust, coexistence, and interfaith unity, dating back to Caliph Omar ibn al-Khattab.

[JAMA @JAMA_current]

📊 JAMA Clinical Guidelines Synopsis: The 2025 guideline for #ACS management recommends dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, high-intensity statins, invasive revascularization, and radial access for angiography.

https://t.co/cRfu42LO0s

[KDIGO @goKDIGO]

The draft of the KDIGO 2026 AKI/AKD Guideline is now available for public review through April 27, 2026.

Download the guideline and submit comments via the feedback form on the guideline website: https://t.co/6kEU9nONnb

This update to the 2012 guideline introduces a unified framework across AKI and AKD, with advances in diagnosis, prevention, and management, including updated recommendations on biomarkers, kidney replacement therapy, and follow-up care.

Recommendations were developed by an international Work Group, including patient representatives, using GRADE methodology.

KDIGO welcomes feedback from the global kidney community. Reviewers may focus on sections most relevant to their expertise, and contributors may be acknowledged in the final publication.

#AKI #AKD

[NEJM @NEJM]

Presented at #ACC26:

Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level below 55 mg per deciliter led to a lower 3-year risk of cardiovascular events than targeting a level below 70 mg per deciliter. Full Ez-PAVE trial results: https://t.co/q0vNdAoJJL

Editorial: Paving the Road toward Targeted Lipid Lowering https://t.co/zUwmo0r0n4

@ACCinTouch

[JAMA @JAMA_current]

📊 JAMA Clinical Guidelines Synopsis: The newly released Surviving #Sepsis Campaign guidelines from ESICM and SCCM endorse early broad-spectrum antibiotics, rapid fluid resuscitation, and deescalation strategies for adults with sepsis or septic shock.

https://t.co/AVBfkuij0j

[Mohan Sai Gudela, DM @drmohansai]

Surviving Sepsis Campaign 2026 Guidelines - Summarised
Some key thoughts got my attention
- Pre hospital antibiotics
- Code Sepsis/ Sepsis Huddle
- No empirical anaerobic or antifungal coverage in sepsis/septic shock unless at high risk for such infections
- Initiating Vasopressors through peripheral line
- Emphasis on De-resuscitation
- Arterial lines if required
- Insufficient evidence for Methylene Blue and Midodrine (gonna change for sure in the following guidelines)
- HFNC over NIV in hypoxemic respiratory failure
Do like and share if you find them useful!
#Sepsis #Septicshock #Survivingsepsiscampaign

[JAMA @JAMA_current]

#ResistantHypertension affects approximately 10% of patients treated for #hypertension and is associated with increased #cardiovascular mortality compared with controlled blood pressure.

📄 Learn more in this Review: https://t.co/I73lEmuACO

[C. Michael Gibson MD @CMichaelGibson]

Download the lipid guidelines slides here

https://t.co/jqVXneFzrO

[Chuck Schumer @SenSchumer]

This is mindless hate. Muslim Americans are cops, doctors, nurses, teachers, bankers, bricklayers, mothers, fathers, neighbors, mayors, and more.

Islamophobic hate like this is fundamentally un-American and we must confront and overcome it whenever it rears its ugly head.

[Paul🥷 @l4pablo]

You're not a big club!

Your lot were out there popping champagne for a fourth straight Premier League title on the exact same day Jürgen Klopp was saying goodbye at Anfield, and the world still chose to watch the emotional farewell over your plastic parade.

More eyes on Klopp's last dance than on City's trophy lift. Speaks volumes.

Stay small. 💪🏻

#LFC

[Liverpool FC @LFC]

Ramadan Kareem from all of us at Liverpool FC  ❤️ #RedTogether

[Ashraf Elghul, MD @mlelghul]

@erling We are Liverpool, the most successful team in English football! Man City Who?
YNWA.

[Dr. Filippo Cademartiri @FCademartiri]

🫀📉 LDL-C management made simple: lower for longer really is better

This 2025 National Lipid Association (NLA) guidance delivers a clear, unified message across complex and sometimes conflicting guidelines: LDL cholesterol is causal for ASCVD, and sustained lowering over time saves lives .

🧠 Why this document matters
Despite decades of evidence, LDL-C measurement and control remain suboptimal, even in patients with established ASCVD. Meanwhile, cardiovascular mortality—especially in younger and middle-aged adults—is rising again. This guidance aims to cut through complexity and offer practical, patient-centered clarity for everyday care.

📌 Core principles (no ambiguity)
LDL-C is the building block of atherosclerotic plaque
ASCVD risk falls linearly and proportionally with LDL-C reduction
Benefit depends on how low you go and how long you stay there👉 Hence the key message: lower for longer is better
📊 Screening & targets

All adults: lipid panel at least every 5 years
High-risk patients or on therapy: more frequent monitoring
LDL-C <100 mg/dL for general prevention
Much lower targets for high and very-high-risk patients
Evidence supports safety of LDL-C levels down to 10–30 mg/dL ✅
💊 Therapy: stepwise but decisive

Statins remain first-line
If targets aren’t reached → add non-statins (ezetimibe, PCSK9 inhibitors, bempedoic acid, etc.)
Combination therapy beats statin dose escalation
Statin intolerance is real—but manageable with alternatives
🥗 Lifestyle still matters

Diet, exercise, sleep, smoking cessation, and stress control are framed not as optional extras, but as foundational LDL-lowering tools.
🔮 The real takeaway

ASCVD is a lifetime exposure disease. Waiting until risk is “high enough” is a missed opportunity. Early identification, sustained LDL-C control, and team-based care—often involving lipid specialists—are key to bending the curve.
🚀 Bottom line

LDL-C management doesn’t need to be complicated.
Measure it. Treat it. Maintain it.
Lower. For longer. Better.

[Ibrahim Hooper @ibrahimhooper]

A man came to the Prophet Muhammad (pbuh) and said: “Teach me something that is not too much for me so that, perhaps, I may abide by it.”...

[Marshall School of Medicine @MUSOMWV]

The Centers for Medicare &amp; Medicaid Services announced West Virginia will receive $199 million through the Rural Health Transformation Fund. Marshall Health Network, @musomwv &amp; @MarshallU congratulate @WVGovernor &amp; the state on this major investment.

🔗 https://t.co/8LOGoAzYEM

[American Gastroenterological Association (AGA) @AmerGastroAssn]

Best practices for managing ascites, volume overload &amp; hyponatremia in cirrhosis.
Our new CPU in @AGA_Gastro shares 1️⃣3️⃣ evidence-based tips to support clinical decision-making.
Read more here: https://t.co/VT2rL72eIJ
@orman_md @BrettEFortuneMD @AsraniSumeet
#GITwitter