Shiva Narayanan @shivn.bsky.social · 10/09/2026A 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 · 03/09/2026The 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 · 31/08/2026Cardiology 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 · 11/08/2026New @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.comCefadroxil as Oral Transitional Therapy for Gram-Positive Bacteremia With or Without Non-Vertebral Osteomyelitis: A Multicenter Retrospective Cohort StudyIn 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 · 06/08/2026week 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 · 30/07/2026Beg 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.comLow-Value Services and Longitudinal Knowledge Assessment PerformanceThis 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 NarayananCarl T. Bergstrom @carlbergstrom.com · 03/06/20261. 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.orgThe diffusion of large language models in published academic articles | PNASLarge 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 NarayananIAS - 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.orgnpr.orgPeople with cancer or HIV could lose Medicaid under new work rules, advocates sayAdults 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 · 01/06/2026PSA about PsA: Blue green sheen, resistance machine, clinically obscene. 010
Reposted by Shiva NarayananDan Vergano @danvergano.bsky.social · 29/05/2026Further analysis of these proposed changes here: elizabethginexi.substack.com/p/summary-of...elizabethginexi.substack.comSummary of Key Changes in OMB’s Proposed Federal Financial Assistance RuleRussell Vought is going destroy American Science 09533
Shiva Narayanan @shivn.bsky.social · 29/05/2026What is the future of #Uptodate in the era of #OpenEvidence? 100
Shiva Narayanan @shivn.bsky.social · 29/05/2026Do you have access to the full article. Stat news is too expensive for me 030
Shiva Narayanan @shivn.bsky.social · 27/05/2026I 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 · 22/05/2026Oh wow- U.S. researchers face new restrictions on publishing with foreign collaborators | Science | AAAS www.science.org/content/arti...science.orgU.S. researchers face new restrictions on publishing with foreign collaboratorsNIH, NASA grantees are confused and concerned amid agencies’ piecemeal communication 022
Reposted by Shiva NarayananSaloni @scientificdiscovery.dev · 22/05/2026Here 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 Narayanansara g miller @saragmiller.bsky.social · 20/05/2026Former 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.comAbsence of USAID likely slowed Ebola detection and response, former officials sayThe State Department denies that changes to USAID have hampered the response to the outbreak. 312265
Shiva Narayanan @shivn.bsky.social · 17/05/2026I hope this doesn’t lead to shortages for people who actually need the drug for a legitimate medical indication 020
Shiva Narayanan @shivn.bsky.social · 12/05/2026As 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 · 07/05/2026Do Dokters need to be TickDockers? www.pewresearch.org/data-labs/20...pewresearch.orgMoms, 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 · 18/03/2026The 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 #HealthcareJobslnkd.in 000
Reposted by Shiva NarayananUniversity 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. #IDSkyacademic.oup.comLumbar Puncture Frequency and Patient Survival Among Persons Hospitalized with Cryptococcal Meningitis in the United StatesAbstract. Elevated intracranial pressure contributes to high mortality in cryptococcal meningitis. We evaluated the association between therapeutic lumbar 086
Reposted by Shiva NarayananUW Infectious Disease Fellowship Program @uwidfellowship.bsky.social · 15/03/2026MMWR this week covering the New Mexico measles outbreak and urging vaccination… www.cdc.gov/mmwr/volumes... #IDSkycdc.govMeasles Outbreak — New Mexico, 2025This report describes a measles outbreak in New Mexico ... 033
Shiva Narayanan @shivn.bsky.social · 14/03/2026That 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 000
Shiva Narayanan @shivn.bsky.social · 13/03/2026Ah. What a disaster. This is like back to the past. #HIV #harmreduction kffhealthnews.org/news/article...kffhealthnews.orgAn HIV Outbreak in Maine Shows the Risk of Trump’s Crackdown on Homelessness and Drug Use - KFF Health NewsPublic 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 · 13/03/2026Proof to start to abandon this practice academic.oup.com/cid/advance-...academic.oup.comIs 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, 2016–2021In 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 · 20/02/2026I 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 papersAnalysis reveals that strange turns of phrase may indicate foul play in science. 000
Shiva Narayanan @shivn.bsky.social · 11/02/2026Their 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.” 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 · 29/01/2026I guess these are imprinted beliefs, with overwhelming motivation to be contrarian as against questioning ourselves , difficult to reason with. 010
Shiva Narayanan @shivn.bsky.social · 29/01/2026I 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 221
Shiva Narayanan @shivn.bsky.social · 22/01/2026Agree @paulsaxmd.bsky.social . I wish more people would sign up 000
Shiva Narayanan @shivn.bsky.social · 15/01/2026You should apply to write questions for the ABIM. They need question writers. 110
Shiva Narayanan @shivn.bsky.social · 12/01/2026A third generation cephalosporin found its way into the #nytimes puzzle section today #IDsky #medsky 020
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. 000
Shiva Narayanan @shivn.bsky.social · 02/01/2026So 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?🤔 100
Shiva Narayanan @shivn.bsky.social · 02/01/2026In 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.govInadvertent Use of Bicillin® C-R to Treat Syphilis Infection --- Los Angeles, California, 1999–2004An official website of the United States government 100
Shiva Narayanan @shivn.bsky.social · 02/01/2026More 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) 100
Shiva Narayanan @shivn.bsky.social · 02/01/2026PK 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. 200
Shiva Narayanan @shivn.bsky.social · 02/01/2026To 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. 100
Shiva Narayanan @shivn.bsky.social · 02/01/2026What 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 110
Shiva Narayanan @shivn.bsky.social · 02/01/2026The 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 · 01/01/2026Resetting to the realm of distributed authority needs doctors to focus on healer role and not someone with expertise alonedoximity.comThe Role of Doctors Is Changing ForeverSome 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 NarayananShiva 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 NarayananJAC-AMR @jac-amr.bsky.social · 30/12/2025This 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 #IDSkydoi.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