Mohammad Jamil, MD

One of my favorite things to teach in MICU is how to ventilate a patient with asthma. some very basic changes can set your patient for success; let me know what else would you do @emireles_c @Thind888 @IM_Crit_ @jamilmshahi @RobChatburn @chatterJ5 @respresource

The Critical waterfall concept of Perfusion in Shock Source: doi.org/10.1016/j.jcrc… @ZonairKhanMD @jamilmshahi @Narpaul94

The most dangerous addiction today isn't a substance. Research on 100,000 people confirms that heavy short-form video use is just voluntary cognitive decline. We are actively training our brains to fail at hard tasks. If you can simply sit with a problem for 10 minutes without swiping, you have a massive competitive advantage. Basically, boredom is the new IQ.

Super proud of you! Onward and upward!

Just a little girl from Quetta,Balochistan, chasing a dream that once felt so far away. Excited to share that I’ve matched into Hem/Onc at @MayoClinic This path has been shaped by my patients who gave my work purpose, and to my family for their unwavering support. I am incredibly grateful to @Zimmermk1986 for giving me the opportunity to build my basic science foundation at Zimmerman Lab, and to @JosephSassineMD for shaping my clinical research training. I am also deeply appreciative of the unwavering guidance and support from @AdanmaAnjiMD @MoKhawandanah @msalmanfaisal @FaizAnwerMD1 Deep gratitude to my @OU_internalmed program for its tremendous support throughout this journey. So excited for the next chapter of my life at @MayoHemeOnc #Fellowmatch #Match2026 @TheNRMP

Presented at #LIVES2025: In the EVERDAC trial involving patients with shock, results for death at day 28 indicated that management without early arterial catheter insertion was noninferior to early catheter insertion. Full trial results: nej.md/3LmOO0D Editorial: A Less Invasive Approach to Intensive Care nej.md/49b1th5

2. EVERDAC: deferring arterial lines in ICU shock ➡️ RCT (n=1006) comparing early vs deferred arterial catheterisation ➡️ 28-day mortality similar (34.3% vs 36.9%) — noninferior ➡️ Arterial-line complications lower (1.0% vs 8.2%) CCR Journal Watch criticalcarereviews.com/latest-evidenc…

CMS finalized a new national coverage document earlier this summer that establishes #Medicare coverage criteria for the use of home mechanical ventilators and respiratory assist devices for patients with #COPD. Access our fact sheet to read more: hubs.la/Q03G6rSG0

I can't believe the Democrats went through all the effort to doctor the Epstein files and then forgot to release them.

@Superman #stop

@jamilmshahi Superman has made his way to Los Angeles.💫 Live stream the Los Angeles premiere on Amazon Live, Instagram, TikTok, X, YouTube, and Twitch today at 4:30pm PST. Get tickets for #Superman now - only in theaters July 11. Link in bio. Reply #stop to opt-out.

@saju_sachin @ResearchOU @OU_internalmed The GOAT 🐐 Good luck for fellowship ahead 👍🏼

I’m truly grateful for the opportunity to serve as one of the 24-25 @OU_internalmed Chiefs. It’s been an incredible year of growth for me. I couldn’t have asked for a more dedicated group of co-chiefs who always placed residents first. Looking forward to all that lies ahead!

Keeping the 🫁 healthy after concluding the Fellows Boot Camp @atscommunity @atsearlycareer #ATS2025

@MessifiedCule10 @TheNRMP Congratulations Zabeeh!

"We fall. We break. We fail. But then, We rise. We heal. We overcome." Finally I have matched into Internal Medicine. So grateful to my family, friends and the incredible alumni of King Edward Medical University. #Imatched #imatched #Match2025 #Match @TheNRMP

Around five years into being an attending is when most doctors start to feel confident in their medical skills. Before this, feeling like you don’t know enough is totally normal. Like many jobs, medicine is experiential. Have to gain experience to have confidence.

Excited to announce 2 of my abstracts have been accepted for poster presentation at #ATS2025 Thankful to my mentors @JosephSassineMD and @Taha_CancerDoc for all the support @atscommunity @ResearchOU @OUCollegeofMed @OU_internalmed @StephensonCC @OUResearch @OUHealth

SUPER BOWL CHAMPIONS! THIS ONE’S FOR YOU PHILLY!

There’s a rule of thumb I was taught that when two pieces of data disagree (like physical exam vs. MRI), the lower tech piece of data is almost always right. I have seen this borne out more times than I can count. If the lab-imaging findings show disaster and the patient is comfortably eating a sandwich, take a breath before you call the OR.

Review of the HAPPEN Randomized Clinical Trial, which evaluates the effect of high-intensity vs. low-intensity noninvasive positive pressure ventilation (NPPV) on the need for endotracheal intubation in acute exacerbations of COPD with hypercapnia. 🔹 Methodology Review ✅ Strengths: • Randomized, multicenter design across 30 hospitals enhances external validity. • Defined inclusion criteria (PaCO₂ > 45 mmHg after 6 hours of low-intensity NPPV) ensure that only patients with persistent hypercapnia were included. • Crossover allowance for the low-intensity group reflects real-world clinical scenarios. • Clear intervention protocols for high- and low-intensity NPPV with detailed titration strategies. • Blinded outcome assessors enhance objectivity in determining the need for intubation. ⚠ Limitations & Concerns: • Single-blind design: Patients and treating physicians were unblinded, potentially introducing bias in decision-making regarding intubation. • Early trial termination due to interim analysis findings and COVID-19 disruptions may have impacted long-term conclusions. • Potential confounding from prior NPPV use: Over 55% of patients had used NPPV before, which might have influenced treatment response. • Limited generalizability: The study population was older (mean age 73 years) and primarily from Chinese hospitals, which may not fully translate to other healthcare settings. 🔹 Statistical Analysis Review ✅ Strengths: • Intention-to-treat analysis ensures robustness by including all randomized patients. • Predefined superiority margin (9% absolute difference in intubation) maintains statistical rigor. • Multiple sensitivity analyses (e.g., per-protocol analysis, adjustments for baseline characteristics) reinforce findings. • Kaplan-Meier and Cox regression models for time-to-event analyses strengthen interpretation. ⚠ Concerns & Weaknesses: • Primary outcome (intubation need) had a significant difference, but actual intubation rates did not (4.8% vs. 13.7% met criteria, but only 3.4% vs. 3.9% were intubated). This suggests that while high-intensity NPPV prevented patients from meeting criteria, it did not necessarily reduce actual intubation rates—raising questions about clinical impact. • 1-sided p-value for primary outcome (P = .004) rather than the conventional 2-sided approach. This increases risk of overestimating statistical significance. • Adjustment for multiple comparisons: The study analyzed 15 secondary outcomes, but only 1 was significantly different, suggesting possible chance findings. • Post hoc subgroup analyses were exploratory and not sufficiently powered. 🔹 Conclusion & Clinical Impact ✅ Key Takeaways: • High-intensity NPPV reduced the proportion of patients meeting intubation criteria. • No significant difference in actual intubation rates or mortality. • Increased abdominal distension in high-intensity NPPV, suggesting potential tolerance issues. • High-intensity NPPV achieved better PaCO₂ reduction, but long-term benefits remain uncertain. ⚠ Limitations in Conclusion: • The crossover design may have diluted differences, making it hard to conclude whether high-intensity NPPV is truly superior. • Did not address long-term COPD outcomes, such as exacerbation frequency or readmissions. • Results conflict with prior studies suggesting high-intensity NPPV improves survival in chronic hypercapnic COPD. 🔹 Final Verdict ✅ Well-designed study with strong methodology but some limitations due to unblinding and early termination. ⚠ Findings suggest high-intensity NPPV improves gas exchange but does not clearly prevent intubation or improve survival. 📌 Future studies should assess long-term outcomes, patient tolerance, and cost-effectiveness.

Here's a video I made breaking down this fascinating case of a young man who was assaulted #FOAMed

I missed this when it came out: 2024 HHS/DKA guidelines: No more "the gap has closed". Following the anion gap is no longer recommended. Instead, follow plasma ketones directly, venous pH, and/or bicarbonate.