Dr Suldan Abdullahi

27/01/2026

𝟐𝟎𝟐𝟔 𝐀𝐇𝐀/𝐀𝐒𝐀 𝐠𝐮𝐢𝐝𝐞𝐥𝐢𝐧𝐞𝐬 𝐨𝐧 𝐀𝐜𝐮𝐭𝐞 𝐈𝐬𝐜𝐡𝐞𝐦𝐢𝐜 𝐒𝐭𝐫𝐨𝐤𝐞 𝐚𝐫𝐞 𝐨𝐮𝐭!

1️⃣ 𝐓𝐢𝐦𝐞 𝐬𝐭𝐢𝐥𝐥 𝐞𝐪𝐮𝐚𝐥𝐬 𝐛𝐫𝐚𝐢𝐧 — but systems now matter as much as speed

The 2026 guideline strongly emphasizes regional stroke systems of care, advocating integrated EMS–hospital networks with measurable quality metrics and rapid transfer pathways, rather than isolated hospital-centric care .

2️⃣ 𝐌𝐨𝐛𝐢𝐥𝐞 𝐒𝐭𝐫𝐨𝐤𝐞 𝐔𝐧𝐢𝐭𝐬 (𝐌𝐒𝐔𝐬) 𝐚𝐫𝐞 𝐧𝐨 𝐥𝐨𝐧𝐠𝐞𝐫 𝐞𝐱𝐩𝐞𝐫𝐢𝐦𝐞𝐧𝐭𝐚𝐥 — they are recommended

Where available, MSUs are recommended over conventional EMS to enable ultra-early thrombolysis and improved functional outcomes, marking a major systems-level upgrade in stroke care .

3️⃣ 𝐃𝐞𝐬𝐭𝐢𝐧𝐚𝐭𝐢𝐨𝐧 𝐦𝐚𝐭𝐭𝐞𝐫𝐬: Not every stroke should go to the nearest hospital

For suspected LVO, transport decisions should consider direct routing to EVT-capable centers, unless robust and rapid interhospital transfer systems exist — shifting from “nearest” to “most appropriate” hospital logic .

4️⃣ 𝐓𝐞𝐧𝐞𝐜𝐭𝐞𝐩𝐥𝐚𝐬𝐞 𝐬𝐭𝐚𝐧𝐝𝐬 𝐞𝐪𝐮𝐚𝐥 𝐭𝐨 𝐚𝐥𝐭𝐞𝐩𝐥𝐚𝐬𝐞 𝐢𝐧 𝐭𝐡𝐞 𝟒.𝟓-𝐡𝐨𝐮𝐫 𝐰𝐢𝐧𝐝𝐨𝐰

The guideline endorses either alteplase or tenecteplase for IV thrombolysis within 4.5 hours, based on multiple trials showing non-inferiority and practical advantages of tenecteplase (bolus dosing, logistics) .

5️⃣ 𝐓𝐫𝐞𝐚𝐭 𝐝𝐢𝐬𝐚𝐛𝐥𝐢𝐧𝐠 𝐬𝐭𝐫𝐨𝐤𝐞 𝐮𝐫𝐠𝐞𝐧𝐭𝐥𝐲 — 𝐢𝐫𝐫𝐞𝐬𝐩𝐞𝐜𝐭𝐢𝐯𝐞 𝐨𝐟 𝐍𝐈𝐇𝐒𝐒 𝐬𝐜𝐨𝐫𝐞

Patients with disabling deficits must receive thrombolysis even with low NIHSS, eliminating the misconception that “low score = no lysis” .

6️⃣ 𝐄𝐱𝐭𝐞𝐧𝐝𝐞𝐝 𝐭𝐡𝐫𝐨𝐦𝐛𝐨𝐥𝐲𝐬𝐢𝐬 𝐧𝐨𝐰 𝐟𝐢𝐫𝐦𝐥𝐲 𝐢𝐦𝐚𝐠𝐞-𝐠𝐮𝐢𝐝𝐞𝐝

IV thrombolysis is reasonable up to 9 hours or wake-up stroke, provided advanced imaging demonstrates salvageable penumbra (DWI-FLAIR or perfusion mismatch) .

7️⃣ 𝐃𝐮𝐚𝐥 𝐚𝐧𝐭𝐢𝐩𝐥𝐚𝐭𝐞𝐥𝐞𝐭𝐬, 𝐧𝐨𝐭 𝐭𝐡𝐫𝐨𝐦𝐛𝐨𝐥𝐲𝐬𝐢𝐬, 𝐟𝐨𝐫 𝐧𝐨𝐧-𝐝𝐢𝐬𝐚𝐛𝐥𝐢𝐧𝐠 𝐦𝐢𝐧𝐨𝐫 𝐬𝐭𝐫𝐨𝐤𝐞

For minor non-disabling stroke within 4.5 hours, trials failed to show thrombolysis benefit — DAPT is preferred in this population .

8️⃣ 𝐄𝐕𝐓 𝐧𝐨𝐰 𝐛𝐞𝐧𝐞𝐟𝐢𝐭𝐬 𝐞𝐯𝐞𝐧 “𝐥𝐚𝐫𝐠𝐞-𝐜𝐨𝐫𝐞” 𝐬𝐭𝐫𝐨𝐤𝐞𝐬 — 𝐬𝐞𝐥𝐞𝐜𝐭𝐞𝐝 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐨𝐧𝐥𝐲

The 2026 guideline expands EVT eligibility to some patients with larger ischemic cores, provided imaging and clinical criteria are met — a paradigm shift from previous exclusions .

9️⃣ 𝐁𝐚𝐬𝐢𝐥𝐚𝐫 𝐚𝐫𝐭𝐞𝐫𝐲 𝐨𝐜𝐜𝐥𝐮𝐬𝐢𝐨𝐧: 𝐄𝐕𝐓 𝐫𝐞𝐜𝐨𝐦𝐦𝐞𝐧𝐝𝐞𝐝 𝐮𝐩 𝐭𝐨 𝟐𝟒 𝐡𝐨𝐮𝐫𝐬

For basilar artery occlusion with NIHSS ≥10 and PC-ASPECTS ≥6, EVT is now strongly recommended within 24 hours — a major advance in posterior circulation stroke care .

🔟 𝐏𝐞𝐝𝐢𝐚𝐭𝐫𝐢𝐜 𝐬𝐭𝐫𝐨𝐤𝐞 𝐞𝐧𝐭𝐞𝐫𝐬 𝐢𝐧𝐭𝐞𝐫𝐯𝐞𝐧𝐭𝐢𝐨𝐧𝐚𝐥 𝐞𝐫𝐚

For the first time, pediatric AIS is addressed:
EVT is reasonable in select children ≥6 years (and even younger in expert centers), and alteplase may be considered within 4.5 hours, though efficacy remains uncertain .

1️⃣1️⃣ 𝐈𝐧𝐭𝐞𝐧𝐬𝐢𝐯𝐞 𝐠𝐥𝐮𝐜𝐨𝐬𝐞 𝐥𝐨𝐰𝐞𝐫𝐢𝐧𝐠 𝐢𝐬 𝐡𝐚𝐫𝐦𝐟𝐮𝐥 — 𝐧𝐨𝐭 𝐡𝐞𝐥𝐩𝐟𝐮𝐥

Targeting glucose aggressively to 80–130 mg/dL increases hypoglycemia without improving outcomes. Avoid “tight” glucose control in AIS .

1️⃣2️⃣ 𝐀𝐠𝐠𝐫𝐞𝐬𝐬𝐢𝐯𝐞 𝐁𝐏 𝐥𝐨𝐰𝐞𝐫𝐢𝐧𝐠 𝐚𝐟𝐭𝐞𝐫 𝐫𝐞𝐩𝐞𝐫𝐟𝐮𝐬𝐢𝐨𝐧 𝐦𝐚𝐲 𝐰𝐨𝐫𝐬𝐞𝐧 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬

Intensive SBP reduction to

12/01/2026

🙋‍♂️𝐈𝐟 𝐚 𝐧𝐞𝐰𝐥𝐲 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐞𝐝 𝐝𝐢𝐚𝐛𝐞𝐭𝐢𝐜 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐜𝐨𝐦𝐞𝐬 𝐭𝐨 𝐮𝐬 𝐰𝐡𝐚𝐭 𝐢𝐧𝐯𝐞𝐬𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧𝐬 𝐬𝐡𝐨𝐮𝐥𝐝 𝐰𝐞 𝐚𝐝𝐯𝐢𝐬𝐞? ❓
:

For a newly diagnosed diabetes patient, the objective of baseline investigations is threefold: (𝟏) 𝐜𝐨𝐧𝐟𝐢𝐫𝐦 𝐚𝐧𝐝 𝐩𝐡𝐞𝐧𝐨𝐭𝐲𝐩𝐞 𝐝𝐢𝐚𝐛𝐞𝐭𝐞𝐬, (𝟐) 𝐚𝐬𝐬𝐞𝐬𝐬 𝐜𝐚𝐫𝐝𝐢𝐨𝐯𝐚𝐬𝐜𝐮𝐥𝐚𝐫 𝐚𝐧𝐝 𝐫𝐞𝐧𝐚𝐥 𝐫𝐢𝐬𝐤, 𝐚𝐧𝐝 (𝟑) 𝐝𝐞𝐭𝐞𝐜𝐭 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬 𝐚𝐥𝐫𝐞𝐚𝐝𝐲 𝐩𝐫𝐞𝐬𝐞𝐧𝐭 𝐚𝐭 𝐝𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬. The following represents a comprehensive, guideline-concordant initial evaluation suitable for routine clinical practice.

🟩𝟏. 𝐆𝐥𝐲𝐜𝐚𝐞𝐦𝐢𝐜 𝐀𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭 (𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬 & 𝐁𝐚𝐬𝐞𝐥𝐢𝐧𝐞 𝐂𝐨𝐧𝐭𝐫𝐨𝐥)

Fasting plasma glucose (FPG)

Post-prandial plasma glucose (PPG) or 2-hour OGTT (if diagnostic uncertainty)

HbA1c (baseline glycaemic burden)

Random plasma glucose (if symptomatic)

𝐏𝐮𝐫𝐩𝐨𝐬𝐞: confirm diagnosis, assess chronic hyperglycaemia, and guide intensity of therapy.

🟩𝟐. 𝐑𝐞𝐧𝐚𝐥 𝐄𝐯𝐚𝐥𝐮𝐚𝐭𝐢𝐨𝐧

Serum creatinine with eGFR

Urine albumin–creatinine ratio (UACR) (spot urine)

Routine urine examination (protein, sediments, infection)

𝐏𝐮𝐫𝐩𝐨𝐬𝐞: detect early diabetic kidney disease and stratify CV risk.

🟩𝟑. 𝐋𝐢𝐩𝐢𝐝 & 𝐂𝐚𝐫𝐝𝐢𝐨𝐯𝐚𝐬𝐜𝐮𝐥𝐚𝐫 𝐑𝐢𝐬𝐤 𝐏𝐫𝐨𝐟𝐢𝐥𝐞

Fasting lipid profile

Total cholesterol

LDL-C

HDL-C

Triglycerides

Non-HDL cholesterol (derived)

Blood pressure measurement

Resting ECG (baseline) in adults, especially >40 years or with risk factors

𝐏𝐮𝐫𝐩𝐨𝐬𝐞: atherosclerotic cardiovascular disease (ASCVD) risk stratification and statin decision.

🟩𝟒. 𝐇𝐞𝐩𝐚𝐭𝐢𝐜 & 𝐌𝐞𝐭𝐚𝐛𝐨𝐥𝐢𝐜 𝐄𝐯𝐚𝐥𝐮𝐚𝐭𝐢𝐨𝐧

Fib-4 Score

Liver function tests (ALT, AST, ALP, bilirubin)

Ultrasound abdomen (if obesity, metabolic syndrome, elevated ALT → screen for MASLD/MASH)

Serum uric acid (optional, cardiometabolic risk marker)

🟩𝟓. 𝐇𝐞𝐦𝐚𝐭𝐨𝐥𝐨𝐠𝐢𝐜 & 𝐆𝐞𝐧𝐞𝐫𝐚𝐥 𝐁𝐢𝐨𝐜𝐡𝐞𝐦𝐢𝐬𝐭𝐫𝐲

Complete blood count (CBC)

Electrolytes (Na⁺, K⁺, bicarbonate)

Serum calcium

Vitamin B12 (especially if metformin anticipated or long-term)

🟩𝟔. 𝐃𝐢𝐚𝐛𝐞𝐭𝐞𝐬 𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐒𝐜𝐫𝐞𝐞𝐧𝐢𝐧𝐠 𝐚𝐭 𝐁𝐚𝐬𝐞𝐥𝐢𝐧𝐞

🔹𝐀. 𝐄𝐲𝐞

Dilated fundus examination / fundus photography (retinopathy may be present at diagnosis in T2D)

🔹𝐁. 𝐊𝐢𝐝𝐧𝐞𝐲

UACR + eGFR (as above)

🔹𝐂. 𝐍𝐞𝐮𝐫𝐨𝐩𝐚𝐭𝐡𝐲 / 𝐅𝐨𝐨𝐭

Comprehensive foot examination
(monofilament, vibration, pulses, deformities, callus, footwear assessment)

🟩𝟕. 𝐄𝐭𝐢𝐨𝐥𝐨𝐠𝐢𝐜𝐚𝐥 / 𝐏𝐡𝐞𝐧𝐨𝐭𝐲𝐩𝐢𝐜 𝐓𝐞𝐬𝐭𝐬 (𝐒𝐞𝐥𝐞𝐜𝐭𝐢𝐯𝐞)

Indicated when presentation is atypical (young, lean, ketosis, rapid progression, insulin dependence):

🔹𝐂-𝐩𝐞𝐩𝐭𝐢𝐝𝐞 (fasting or stimulated)

🔹𝐀𝐮𝐭𝐨𝐚𝐧𝐭𝐢𝐛𝐨𝐝𝐢𝐞𝐬: GAD-65, IA-2, ZnT8 (suspected LADA / type 1)

🔹𝐊𝐞𝐭𝐨𝐧𝐞𝐬 (urine or blood) if symptomatic or hyperglycaemia >300 mg/dL

🟩𝟖. 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐨𝐧 & 𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐯𝐞 𝐇𝐞𝐚𝐥𝐭𝐡 (𝐚𝐬 𝐚𝐩𝐩𝐫𝐨𝐩𝐫𝐢𝐚𝐭𝐞)

Hepatitis B, Hepatitis C, HIV (if risk factors)

Vaccination status review: influenza, pneumococcal, hepatitis B

Thyroid function tests (especially in T1D, women, or autoimmune background)

🟩𝟗. 𝐀𝐝𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐓𝐞𝐬𝐭𝐬 𝐢𝐧 𝐇𝐢𝐠𝐡-𝐑𝐢𝐬𝐤 𝐨𝐫 𝐒𝐩𝐞𝐜𝐢𝐚𝐥 𝐒𝐢𝐭𝐮𝐚𝐭𝐢𝐨𝐧𝐬

High-sensitivity CRP (CV risk refinement, optional)

Coronary risk assessment (stress test / CT-CAC) in selected high-risk asymptomatic individuals

Testosterone (men), PCOS evaluation (women) if clinically indicated

🎯𝐌𝐢𝐧𝐢𝐦𝐮𝐦 𝐂𝐨𝐫𝐞 𝐏𝐚𝐧𝐞𝐥 (𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐚𝐥 𝐂𝐥𝐢𝐧𝐢𝐜 𝐒𝐞𝐭)🎯

If resources are limited, the essential baseline panel should include:

FPG / PPG

HbA1c

Serum creatinine + eGFR

UACR

Fasting lipid profile

LFTs

CBC

Fundus examination

Comprehensive foot examination

Fib-4 Score

Follow-Up Frequency (Key Parameters)

HbA1c: every 3 months until controlled, then 6-monthly

UACR & eGFR: annually (6-monthly if abnormal)

Lipid profile: annually (or 6–12 weeks after statin initiation)

Eye exam: annually

Foot exam: every visit / at least annually

11/01/2026

📌 waxad halkan si sahlan uga heli kartaa dhamaan guidelines asaaska ah (ADA, KDIGO, ACC/AHA, ESC, etc.) in one place — with quick summaries and point-of-care tools.

🔗 https://www.guidelinecentral.com/

11/01/2026

10/01/2026

𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐚𝐥 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐩𝐨𝐢𝐧𝐭𝐞𝐫𝐬 𝐭𝐨 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐢𝐚𝐭𝐞 𝐃𝐢𝐚𝐛𝐞𝐭𝐢𝐜 𝐊𝐢𝐝𝐧𝐞𝐲 𝐃𝐢𝐬𝐞𝐚𝐬𝐞 (𝐃𝐊𝐃) 𝐟𝐫𝐨𝐦 𝐍𝐨𝐧-𝐃𝐢𝐚𝐛𝐞𝐭𝐢𝐜 𝐊𝐢𝐝𝐧𝐞𝐲 𝐃𝐢𝐬𝐞𝐚𝐬𝐞 (𝐍𝐃𝐊𝐃)

✳️ 𝐅𝐞𝐚𝐭𝐮𝐫𝐞𝐬 𝐒𝐮𝐠𝐠𝐞𝐬𝐭𝐢𝐧𝐠 𝐓𝐲𝐩𝐢𝐜𝐚𝐥 𝐃𝐊𝐃

🔹Long duration of diabetes
Usually >10 years in type 1 and >5–10 years in type 2 diabetes.

🔹Presence of diabetic retinopathy
Strongly correlates with DKD; absence raises suspicion of NDKD.

🔹Gradual onset of albuminuria
Progression: normoalbuminuria → microalbuminuria → overt proteinuria.

🔹Slow, predictable decline in eGFR
Progressive, over years rather than sudden deterioration.

🔹Bland urinary sediment
No hematuria, red cell casts, or active sediment.

🔹Hypertension and other microvascular complications
Neuropathy, retinopathy, and autonomic dysfunction often coexist.

🔹Symmetric kidney size on imaging
No marked asymmetry or structural abnormalities.

✳️𝐑𝐞𝐝 𝐅𝐥𝐚𝐠𝐬 𝐒𝐮𝐠𝐠𝐞𝐬𝐭𝐢𝐧𝐠 𝐍𝐃𝐊𝐃

🔸Short diabetes duration
Renal disease appearing within

25/12/2025

Ten rules for the doctors

1. Be truthful.
Practice medicine the way you would want it practiced on you. Integrity in thought, speech, and action is non-negotiable.

2. Stay organized.
Your cognitive bandwidth is finite. Use systems (calendars, lists, routines) to reduce chaos and prevent avoidable errors.

3. Learn from mistakes.
You will err. Analyze failures honestly, correct course, and do not repeat them. Reflection is a professional obligation.

4. Ask.
Ignorance concealed is dangerous. Seek input from seniors, peers, nurses, and allied staff early and without embarrassment.

5. Communicate clearly.
Medicine fails when communication fails. Be precise, listen actively, avoid jargon, and confirm understanding.

6. Listen to patients.
Symptoms, fears, and values are data. Attention is not optional; it is diagnostic and therapeutic.

7. Stay sane.
You will encounter suffering, injustice, and death. Remain lucid and mentally intact. Protect time for recovery, burnout helps no one.

8. Stay curious.
Clinical competence decays without inquiry. Read, question, and adapt as evidence evolves.

9. Stand up.
Have principles. Authority does not equal correctness. Advocate for patients and for sound medicine, even when uncomfortable.

10. Be sincere.
Remember why you entered medicine. Let purpose, not convenience or fear, guide your conduct.

"A good doctor in a privileged or sh*tty hospital is still a good doctor" taken from my good

20/12/2025

1. 𝐒𝐓𝐀𝐓𝐈𝐍𝐒: 𝐓𝐡𝐞 𝐒𝐢𝐥𝐞𝐧𝐭 𝐂𝐚𝐫𝐝𝐢𝐨𝐩𝐫𝐨𝐭𝐞𝐜𝐭𝐨𝐫𝐬

A deep dive into how statins save lives — who needs them, how to choose, how to monitor, and what not to fear.

Let’s break myths, simplify guidelines & apply it to the Indian setting👇

🧠 𝟐. 𝐖𝐡𝐚𝐭 𝐚𝐫𝐞 𝐒𝐭𝐚𝐭𝐢𝐧𝐬?

Statins = HMG-CoA reductase inhibitors → block hepatic cholesterol synthesis → ↓LDL-C & ↑LDL receptor activity.

They’re the cornerstone for 1ry & 2ry prevention of ASCVD (heart attack, stroke, PAD).

𝟑: 𝐇𝐨𝐰 𝐬𝐭𝐫𝐨𝐧𝐠 𝐢𝐬 𝐲𝐨𝐮𝐫 𝐬𝐭𝐚𝐭𝐢𝐧?

💪 High-intensity (↓LDL ≥50%) → Atorvas 40–80 mg / Rosuvas 20–40 mg

⚖️ Moderate-intensity (↓LDL 30–49%) → Atorvas 10–20 mg / Rosuvas 5–10 mg / Simvas 20–40 mg

💤 Low-intensity (↓LDL

16/12/2025

🚨 Diabetes Diagnosis in 4 SIMPLE Steps! 🩸

Struggling to spot diabetes early? This infographic breaks down the EXACT criteria:

✅ HbA1c ≥6.5% (NGSP-certified)
✅ Fasting Plasma Glucose ≥126 mg/dL (8hr fast)
✅ 2h PG ≥200 mg/dL (OGTT)
✅ Random PG ≥200 mg/dL (with classic symptoms)

2 abnormal tests needed if no symptoms!
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14/12/2025

💊 Empiric antibiotics don’t need guesswork. They need structure.

A simple 2025-ready approach:
✔ Treat only when bacterial infection is likely
✔ Start smart for UTI, CAP, cellulitis
✔ Skip antibiotics when they won’t help
✔ Adjust for kidneys — don’t harm while helping
✔ Reassess at 48–72h and de-escalate

Good antibiotics save lives.
Unnecessary ones create resistance.

14/12/2025

Normal blood pressure does not rule out sepsis.

Lactate ≥2 mmol/L, delayed vasopressors, fluid overload, and missed sources are where outcomes are decided.

A practical 2025 guide to sepsis recognition and early management.