Sign in

Shiva Narayanan

@shivn.bsky.social
2K followers 177 following 159 posts

Physician MD, FIDSA. Interests: Inf diseases, bedside medicine, diagnosis, SUD, HIV/HCV. Associate Professor @UMMedschool @IHVMaryland I seek knowledge not followers

PostsRepliesMedia
Shiva Narayanan @shivn.bsky.social · 10/09/2026
A paraplegic patient with a suprapubic catheter was upset and fired me when I wouldn’t culture cloudy urine. Years of “cloudy urine = UTI” had taught him otherwise. Bad medicine doesn’t just overtreat. Repeated enough, it teaches bad beliefs, and makes good medicine look like neglect.
010
Shiva Narayanan @shivn.bsky.social · 03/09/2026
The Jason Arday tragedy makes me wonder if academia should examine how it actually needs fewer heroes and for people with opportunity for accomplishment to remain human and not fall prey to credential inflation and the subsequent ruthless audit.
010
Shiva Narayanan @shivn.bsky.social · 31/08/2026
Cardiology seems to have taken over this week’s @NEJM. Saw DAPT and instinctively thought daptomycin; should’ve stayed a little longer to SAVR all that TAVR.
000
Shiva Narayanan @shivn.bsky.social · 11/08/2026
New @ofidjournal.bsky.social data shows cefadroxil is a robust, well-tolerated oral step-down for Gram-positive bacteremia & osteomyelitis. Rethink the "Linezolid or bust" reflex! academic.oup.com/ofid/article...
academic.oup.com
Cefadroxil as Oral Transitional Therapy for Gram-Positive Bacteremia With or Without Non-Vertebral Osteomyelitis: A Multicenter Retrospective Cohort Study
In this multicenter, retrospective cohort study, cefadroxil was an effective and safe oral transitional therapy for bloodstream infections, with or without
084
Shiva Narayanan @shivn.bsky.social · 06/08/2026
week on clinical service and I’ve encountered the holy grail: "bilateral monocular diplopia." Nice to know every specialty has its own version of "bilateral lower extremity cellulitis." #IDsky #MedicalMyths #MedTwitter
010
Shiva Narayanan @shivn.bsky.social · 30/07/2026
Beg to disagree with this conclusion #ABIM - LKA score quartiles explained 0.4% of total variation in LVS use. LKA content probably overlaps with the LVS measures, a seeming circularity, no? jamanetwork.com/journals/jam...
jamanetwork.com
Low-Value Services and Longitudinal Knowledge Assessment Performance
This cross-sectional study assesses the association of scores on the American Board of Internal Medicine’s longitudinal knowledge assessment and use of low-value services.
000
Reposted by Shiva Narayanan
Carl T. Bergstrom @carlbergstrom.com · 03/06/2026
1. How common is LLM use in scientific publishing, and how does it vary across field, publisher, journal prestige, author demographics etc.? @kylesiler.bsky.social has new paper in PNAS that addresses this question on a massive scale: 7.3 million papers from Elsevier, PLOS, MDPI, and Frontiers.
pnas.org
The diffusion of large language models in published academic articles | PNAS
Large language models (LLMs) are rapidly changing academic research, raising questions of who is adopting these tools and under what conditions. Th...
9463245
Reposted by Shiva Narayanan
IAS - the International AIDS Society @iasociety.bsky.social · 04/06/2026
"People with cancer or #HIV could lose Medicaid under new work rules, advocates say" via @npr.org
npr.org
People with cancer or HIV could lose Medicaid under new work rules, advocates say
Adults on Medicaid will be required to work 80 hours per month. The Trump administration says people who are sick will have to prove they are too sick to work to be exempt from the new work rules.
012
Shiva Narayanan @shivn.bsky.social · 01/06/2026
PSA about PsA: Blue green sheen, resistance machine, clinically obscene.
010
Reposted by Shiva Narayanan
Dan Vergano @danvergano.bsky.social · 29/05/2026
Further analysis of these proposed changes here: elizabethginexi.substack.com/p/summary-of...
elizabethginexi.substack.com
Summary of Key Changes in OMB’s Proposed Federal Financial Assistance Rule
Russell Vought is going destroy American Science
09533
Shiva Narayanan @shivn.bsky.social · 29/05/2026
What is the future of #Uptodate in the era of #OpenEvidence?
100
Shiva Narayanan @shivn.bsky.social · 27/05/2026
I fed all information about DOR/ISL, the most unexciting new drug in the ARV armamentarium and asked Gemini to make a slide infographic
010
Shiva Narayanan @shivn.bsky.social · 22/05/2026
Oh wow- U.S. researchers face new restrictions on publishing with foreign collaborators | Science | AAAS www.science.org/content/arti...
science.org
U.S. researchers face new restrictions on publishing with foreign collaborators
NIH, NASA grantees are confused and concerned amid agencies’ piecemeal communication
022
Reposted by Shiva Narayanan
Saloni @scientificdiscovery.dev · 22/05/2026
Here are some of my favourite Lexis plots. 1. link.springer.com/article/10.1... 2. ourworldindata.org/causes-of-de... 3. www.demographic-research.org/volumes/vol3...
1185
Reposted by Shiva Narayanan
sara g miller @saragmiller.bsky.social · 20/05/2026
Former top officials at USAID, CDC, NIH and the White House said that if USAID was still intact, it’s possible its resources might have helped contain the virus in this new outbreak and even saved lives. www.nbcnews.com/health/healt...
nbcnews.com
Absence of USAID likely slowed Ebola detection and response, former officials say
The State Department denies that changes to USAID have hampered the response to the outbreak.
312265
Shiva Narayanan @shivn.bsky.social · 12/05/2026
As we use tools like #openevidence more, what are the guardrails against knowledge collapse? Is it all up to the user's volition, good habits? Can knowledge seeking be an addiction like doomscrolling?
010
Shiva Narayanan @shivn.bsky.social · 07/05/2026
Do Dokters need to be TickDockers? www.pewresearch.org/data-labs/20...
pewresearch.org
Moms, Coaches, Doctors, Entrepreneurs: Who Are America’s Health and Wellness Influencers?
Half of U.S. adults under 50 say they get health and wellness information from social media influencers or podcasts. About 4 in 10 of these influencers describe themselves as health care professionals...
000
Shiva Narayanan @shivn.bsky.social · 23/04/2026
Achievement unlocked
000
Shiva Narayanan @shivn.bsky.social · 18/03/2026
The THRIVE Program at the University of Maryland is looking for a HIV/ID Nurse Practitioner who wants to do meaningful, patient-centered work in a truly mission-driven setting.🔗 Apply here: umb.taleo.net/careersectio... . #HIVCare #InfectiousDiseases #PublicHealth #Baltimore #HealthcareJobs
lnkd.in
000
Reposted by Shiva Narayanan
University of Minnesota Infectious Diseases @umn-idim.bsky.social · 15/03/2026
🚨A new study by incoming fellow Dr. Okuno, mentored by faculty Dr. Boulware and Dr. Bahr, evaluates the association between therapeutic LPs and survival in patients with Cryptococcal Meningitis. The Findings: repeat LPs are a life-saving intervention across diverse patient populations. #IDSky
academic.oup.com
Lumbar Puncture Frequency and Patient Survival Among Persons Hospitalized with Cryptococcal Meningitis in the United States
Abstract. Elevated intracranial pressure contributes to high mortality in cryptococcal meningitis. We evaluated the association between therapeutic lumbar
086
Reposted by Shiva Narayanan
UW Infectious Disease Fellowship Program @uwidfellowship.bsky.social · 15/03/2026
MMWR this week covering the New Mexico measles outbreak and urging vaccination… www.cdc.gov/mmwr/volumes... #IDSky
cdc.gov
Measles Outbreak — New Mexico, 2025
This report describes a measles outbreak in New Mexico ...
033
Shiva Narayanan @shivn.bsky.social · 13/03/2026
Ah. What a disaster. This is like back to the past. #HIV #harmreduction kffhealthnews.org/news/article...
kffhealthnews.org
An HIV Outbreak in Maine Shows the Risk of Trump’s Crackdown on Homelessness and Drug Use - KFF Health News
Public health experts and advocates say the outbreak has been fueled by a confluence of local factors, including the sweeping of a homeless encampment and shuttering of a sterile-syringe program. But ...
011
Shiva Narayanan @shivn.bsky.social · 13/03/2026
Proof to start to abandon this practice academic.oup.com/cid/advance-...
academic.oup.com
Is 3 Really What We Need? Relative Effectiveness of Benzathine Penicillin G and Doxycycline Treatment Regimens for Late or Unknown Duration Syphilis in 6 US Jurisdictions, 2016–2021
In this retrospective cohort analysis using surveillance data, appropriate serological response by 24 months was comparable among persons with late or unkn
000
Shiva Narayanan @shivn.bsky.social · 20/02/2026
I love how GPT turns Amelia Bedelia in converting random value to irregular esteem....:-) #medsky www.nature.com/articles/d41...
nature.com
‘Tortured phrases’ give away fabricated research papers
Analysis reveals that strange turns of phrase may indicate foul play in science.
000
Shiva Narayanan @shivn.bsky.social · 11/02/2026
“To say that physicians are good or bad would be to imply that there are well-accepted standards of performance and random audits to judge them by; but there are none.
100
Shiva Narayanan @shivn.bsky.social · 16/01/2026
xkcd.com/2749
xkcd.com
Lymphocytes
010
Shiva Narayanan @shivn.bsky.social · 12/01/2026
A third generation cephalosporin found its way into the #nytimes puzzle section today #IDsky #medsky
020
Shiva Narayanan @shivn.bsky.social · 02/01/2026
The 3-dose regimen for late latent syphilis rests on remarkably thin evidence. The logic: organisms dividing more slowly in long-standing infection require prolonged treponemicidal penicillin levels → hence weekly benzathine penicillin G (BPG) ×3.
110
Shiva Narayanan @shivn.bsky.social · 01/01/2026
Resetting to the realm of distributed authority needs doctors to focus on healer role and not someone with expertise alone
doximity.com
The Role of Doctors Is Changing Forever
Some patients don’t trust us. Others say they don’t need us. It’s time for us to think of ourselves not as the high priests of health care but as what we have always been: healers.
000
Reposted by Shiva Narayanan
Shiva Narayanan @shivn.bsky.social · 30/12/2025
#IDsky has anyone used emocha like vDOT for HIV pill adherence/accountability in a SDM framework? #HIV. Any success or logistical challenges?
001
Reposted by Shiva Narayanan
JAC-AMR @jac-amr.bsky.social · 30/12/2025
This paper investigates how resistance to antibiotics used for simple UTIs affects the resistance rate to antibiotics used to treat pyelonephritis: doi.org/10.1093/jaca... #JACAMRNews #IDSky
doi.org
044
Shiva Narayanan @shivn.bsky.social · 30/12/2025
#IDsky has anyone used emocha like vDOT for HIV pill adherence/accountability in a SDM framework? #HIV. Any success or logistical challenges?
001
Shiva Narayanan @shivn.bsky.social · 19/12/2025
#IDsky
000
Shiva Narayanan @shivn.bsky.social · 05/12/2025
Thank you @mdhealthdept.bsky.social
000
Shiva Narayanan @shivn.bsky.social · 04/12/2025
Following the #ACIP discussion, #HepatitisB pmc.ncbi.nlm.nih.gov/articles/PMC...
123
Reposted by Shiva Narayanan
Bryan Carmody @jbcarmody.bsky.social · 03/12/2025
It’s Fellowship Match Day!
Graphic demonstrating the percentage of positions filled by fellowship specialty in the 2025 NRMP Medicine and Pediatric Specialties Match. Cardiology, Hematology-Oncology, Gastroenterology, and Rheumatology filled 99% or more of their available positions, while Geriatric Medicine, Child Abuse Pediatrics, and Pediatric Nephrology filled 41% or less.Graphic demonstrating the applicant match rate for specialty fellowships in the 2025 NRMP Medicine and Pediatric Specialties Match. Match rates for Gastroenterology, Cardiology, and Hematology-Oncology were all <70%, while Pediatric Endocrinology, Neonatal-Perinatal Medicine, Pediatric Hematology-Oncology, Pediatric Rheumatology, and Child Abuse Pediatrics were all >98%.
0255
Shiva Narayanan @shivn.bsky.social · 03/12/2025
Congratulations to everyone who matched to their desired fellowship positions #NRMP #IDsky
020
Shiva Narayanan @shivn.bsky.social · 03/12/2025
Is #SONIA one of the most important public health relevant infectious disease studies? 30% patients were hypoxemic and 9% had hypotension. Rather surprised by the high mortality of nearly 25% in groups which would reflect a really high PSI (class V) #IDsky
030
Shiva Narayanan @shivn.bsky.social · 03/12/2025
BMJ once published 7 alternatives to EBM - add to that now inpertinence based medicine sciencebasedmedicine.org/to-deny-the-...
110
Shiva Narayanan @shivn.bsky.social · 21/11/2025
So sad…..I can see how this type of messaging can plant a seed of doubt in someone like my family member whose child is on the autism spectrum and might not be equipped with the ability to access, review, analyze all the science in this field www.cdc.gov/vaccine-safe...
cdc.gov
Autism and Vaccines
Answers to common questions about vaccine safety and autism.
000
Shiva Narayanan @shivn.bsky.social · 09/11/2025
I’m surprised the tone of this podcast is so apologetic - who are the people the hosts are blaming as being condescending? podcasts.apple.com/us/podcast/l...
podcasts.apple.com
Live from IDWeek 2025: Infectious Diseases Hot Takes
Podcast Episode · Let's Talk ID · 11/08/2025 · 27m
010
Shiva Narayanan @shivn.bsky.social · 07/11/2025
I sometimes flirt with the contrarian myself to wonder whether ID as a specialty issue should even exist- irritated to see medicine teams consult for infectious syndrome that should be managed by the primary team ( cystitis,cellulitis etc) . Seems like disincentivizing common sense mgmt
000
Shiva Narayanan @shivn.bsky.social · 05/11/2025
link.springer.com/article/10.3... An interesting take on availability bias in estimation of demographic proportions - quite interesting read!
link.springer.com
Bias and ignorance in demographic perception - Psychonomic Bulletin & Review
When it comes to knowledge of demographic facts, misinformation appears to be the norm. Americans massively overestimate the proportions of their fellow citizens who are immigrants, Muslim, LGBTQ, and...
010
Shiva Narayanan @shivn.bsky.social · 21/10/2025
Happy Diwali to all who celebrate !
000
Reposted by Shiva Narayanan
Carl T. Bergstrom @carlbergstrom.com · 18/10/2025
This morning my ChatGPT quota was inexplicably exhausted. It took a while but I pieced it together. Voice mode somehow got activated when I went to bed. The bot then engaged in a 10 hour conversation with my snoring dog, answering questions the pup wasn’t asking and praising him for his insight.
903265569
Shiva Narayanan @shivn.bsky.social · 09/10/2025
The book, which unfolds in a single sentence, evokes fears about the rise of fascism in Europe……. It features only one period in its 400 pages!!! 🤔😲.” www.nytimes.com/2025/10/09/b...
nytimes.com
Laszlo Krasznahorkai Is Awarded Nobel Prize in Literature
021
Shiva Narayanan @shivn.bsky.social · 03/10/2025
Reading this on the nursing station after talking to residents about note bloat and unnecessary issues in the chart which make MDM tenuous
000
Shiva Narayanan @shivn.bsky.social · 17/09/2025
pubmed.ncbi.nlm.nih.gov/40840485/ via @thelancetinfdis.bsky.social
pubmed.ncbi.nlm.nih.gov
A clinical practice guideline for tuberculous meningitis - PubMed
Tuberculous meningitis is the most severe form of tuberculosis, causing death or disability in around half of those affected. There are no up-to-date international guidelines defining its optimal mana...
000
Shiva Narayanan @shivn.bsky.social · 16/09/2025
From one SMH moment to another - this is beyond my level of comprehension as ID physician. C.D.C. Vaccine Advisers May Limit Hepatitis B Shots for Newborns www.nytimes.com/2025/09/16/h...
nytimes.com
C.D.C. Vaccine Advisers May Limit Hepatitis B Shots for Newborns
13112
Shiva Narayanan @shivn.bsky.social · 11/09/2025
One of my clinic patients keeps referring to CD4 counts as CDC counts 🤷🏽‍♂️🤔
010