Shiva Narayanan

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

[Shiva Narayanan @shivn]

What is the future of #Uptodate in the era of #OpenEvidence?

[Shiva Narayanan @shivn]

I fed known information about DOR/ISL, the most unexciting new drug in the ARV armamentarium and asked Gemini to make a slide infographic

[Shiva Narayanan @shivn]

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?

[Shiva Narayanan @shivn]

https://t.co/xx1zT5RqON - do Doktors need to be TickDockers?

[Shiva Narayanan @shivn]

@arjunmanrai And the fact that sometimes histories are not completely available or filled in from different sources over time. Physician interview skills have stenosed to accommodate the H/P template and not the iterative hypothesis testing an H/P is supposed to be

[Shiva Narayanan @shivn]

Achievement unlocked

[Shiva Narayanan @shivn]

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: https://t.co/HWMdslmSVl #HIVCare #InfectiousDiseases #PublicHealth #Baltimore

[Shiva Narayanan @shivn]

Proof that we need to reconsider or abandon this practice https://t.co/ya9NXueuV9

[Shiva Narayanan @shivn]

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.

[Satya Nadella @satyanadella]

Congratulations to Team India on a fantastic T20 World Cup win 🇮🇳 Tough luck today, New Zealand.

@Jaspritbumrah93, once again a match winner when it mattered most. @IamSanjuSamson, what a tournament and what an impact. Absolutely incredible.

[Shiva Narayanan @shivn]

Not sticking here in HoCo @capitalweather

[Aziz Sunderji @AzizSunderji]

Jeff Bezos's lifetime charitable giving: ~$4 billion, or about 2 months of his wealth's passive growth. Half a percent of his fortune would fund the Washington Post in perpetuity. Even Gilded Age plutocrats were far more generous. Where's a good robber baron when you need one?

[Shiva Narayanan @shivn]

I love how GPT turns Amelia Bedelia in converting random value to irregular esteem....:-) https://t.co/6HII7Kaor1

[Shiva Narayanan @shivn]

A third generation cephalosporin found its way into the #nyt puzzle section today #idtwitter #idsky

[Shiva Narayanan @shivn]

➡️Perhaps one dose is ok in older pts?🤔
➡️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.

[Shiva Narayanan @shivn]

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.

[Shiva Narayanan @shivn]

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).