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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

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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.
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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.
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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.
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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
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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
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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.
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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...
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Shiva Narayanan @shivn.bsky.social · 04/06/2026
Lol
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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.
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Shiva Narayanan @shivn.bsky.social · 01/06/2026
PSA about PsA: Blue green sheen, resistance machine, clinically obscene.
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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
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Shiva Narayanan @shivn.bsky.social · 29/05/2026
What is the future of #Uptodate in the era of #OpenEvidence?
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Shiva Narayanan @shivn.bsky.social · 29/05/2026
Do you have access to the full article. Stat news is too expensive for me
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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
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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
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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...
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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.
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Shiva Narayanan @shivn.bsky.social · 17/05/2026
I hope this doesn’t lead to shortages for people who actually need the drug for a legitimate medical indication
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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?
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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...
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Shiva Narayanan @shivn.bsky.social · 23/04/2026
Achievement unlocked
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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
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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
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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 ...
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Shiva Narayanan @shivn.bsky.social · 14/03/2026
That said when policy or implementation disadvantages health access to a majority of people you might see or provide care to I don’t see why it would be wrong to say this is not fair or appropriate, when asked
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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 ...
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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
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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.
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Shiva Narayanan @shivn.bsky.social · 11/02/2026
Their nearly total freedom to determine the context of their professional activities and their own standards within this context, especially in the private office where much of medicine is practiced, precludes any rational conviction about the effects of their efforts.”
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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.
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Shiva Narayanan @shivn.bsky.social · 02/02/2026
Great piece @patrickching.bsky.social
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Shiva Narayanan @shivn.bsky.social · 29/01/2026
I guess these are imprinted beliefs, with overwhelming motivation to be contrarian as against questioning ourselves , difficult to reason with.
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Shiva Narayanan @shivn.bsky.social · 29/01/2026
I remember reading Kary Mullis’ foreword to that book and it is fascinating how when people become obsessed with an idea beyond its individual merit they become ego defensive feeding their own confirmation biases
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Shiva Narayanan @shivn.bsky.social · 22/01/2026
Agree @paulsaxmd.bsky.social . I wish more people would sign up
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Shiva Narayanan @shivn.bsky.social · 16/01/2026
xkcd.com/2749
xkcd.com
Lymphocytes
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Shiva Narayanan @shivn.bsky.social · 15/01/2026
You should apply to write questions for the ABIM. They need question writers.
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Shiva Narayanan @shivn.bsky.social · 12/01/2026
A third generation cephalosporin found its way into the #nytimes puzzle section today #IDsky #medsky
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
Correction 1.2MU
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
➡️Can we do 2 doses instead of 3? ➡️More importantly, what is late latent syphilis in PLWHIV? Is it one year? 6 months? No prior titers? ➡️With Benzathine penicillin shortages, I think this is not moot.
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
So what can we conclude? ➡️The 3-dose late latent syphilis regimen is built on an assumed treponemicidal level. ➡️ There is no data about this dosing in the HIV era!! ➡️There are differences in PCNG levels in young vs old populations. (PCN is renally excreted). Perhaps one dose is ok in older pts?🤔
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
In CA/MD when there was inadvertent administration of Bicillin CR instead of Bicillin LA treatment failure rates were not significantly different between patients despite Bicillin CR containing only half the recommended dose of benzathine penicillin G pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov
Inadvertent Use of Bicillin® C-R to Treat Syphilis Infection --- Los Angeles, California, 1999–2004
An official website of the United States government
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
More recent PK simulations suggest levels may dip below 0.02 µg/mL around 2 weeks — but those models often use 1.2 MU, not the 2.4 MU dose used for syphilis (PMID 25182635)
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
PK data for BPG: • Young adults, single 2.4 MU dose: – 0.2 µg/mL at 48h--> – 0.05 µg/mL at 6 days-->– 0.02 µg/mL at ~13 days. Elderly adults, same dose: – ~0.04 µg/mL still present at 20 days So a single 1.2MU BPG dose maintains “rheumatic-fever-level” penicillin for ~2–3 weeks, depending on age.
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
To anchor this to something better studied: rheumatic fever prophylaxis. For decades, the accepted minimum effective penicillin level to suppress group A strep is ~0.02 µg/mL. → That’s why BPG is dosed every 4 weeks, with q3-week dosing only in higher-risk populations.
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Shiva Narayanan @shivn.bsky.social · 02/01/2026
What is a “treponemicidal” level of penicillin? No one actually knows. Older literature (PMID 20604419) assumed a penicillinemia of ~0.03 IU/mL (~0.02 µg/mL) — described vaguely as “several times the serum and tissue levels needed to kill T. pallidum.” This was assumed to be an "insurance" dose
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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.
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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.
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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?
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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
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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?
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