Shiva Narayanan
@shivn.bsky.social
Physician MD, FIDSA. Interests: Inf diseases, bedside medicine, diagnosis, SUD, HIV/HCV. Associate Professor @UMMedschool @IHVMaryland I seek knowledge not followers
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.
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.
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.
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...
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
academic.oup.com
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
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...
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.
jamanetwork.com
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.
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...
pnas.org
"People with cancer or #HIV could lose Medicaid under new work rules, advocates say" via @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.
npr.org
PSA about PsA: Blue green sheen, resistance machine, clinically obscene.
Antibiotic Steward 🅱️C🆔🅿️🌟@absteward.bsky.social · 4mo agoPseudomonas sparing’ antibiotics,is it time to rethink this notion? 🆕Prolonged in vitro exposure of P.aeruginosa to subinhibitory concentrations of Abx lacking intrinsic antipseudomonal activity selects for stable,heritable resistance to antipseudomonal agents #idsky academic.oup.com/jac/article/...
What is the future of #Uptodate in the era of #OpenEvidence?
I fed all information about DOR/ISL, the most unexciting new drug in the ARV armamentarium and asked Gemini to make a slide infographic
Oh wow- U.S. researchers face new restrictions on publishing with foreign collaborators | Science | AAAS www.science.org/content/arti...
U.S. researchers face new restrictions on publishing with foreign collaborators
NIH, NASA grantees are confused and concerned amid agencies’ piecemeal communication
science.org
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...
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...
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.
nbcnews.com
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?
Do Dokters need to be TickDockers? www.pewresearch.org/data-labs/20...
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...
pewresearch.org
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
🚨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
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
academic.oup.com
MMWR this week covering the New Mexico measles outbreak and urging vaccination… www.cdc.gov/mmwr/volumes... #IDSky
Measles Outbreak — New Mexico, 2025
This report describes a measles outbreak in New Mexico ...
cdc.gov
Ah. What a disaster. This is like back to the past. #HIV #harmreduction kffhealthnews.org/news/article...
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 ...
kffhealthnews.org
Proof to start to abandon this practice academic.oup.com/cid/advance-...
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
academic.oup.com
Shiva Narayanan@shivn.bsky.social · 9mo agoThe 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.
I love how GPT turns Amelia Bedelia in converting random value to irregular esteem....:-) #medsky www.nature.com/articles/d41...
‘Tortured phrases’ give away fabricated research papers
Analysis reveals that strange turns of phrase may indicate foul play in science.
nature.com
“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.
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.
Resetting to the realm of distributed authority needs doctors to focus on healer role and not someone with expertise alone
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.
doximity.com
