Tom Boyles
@tomboylesid.bsky.social
ID clinician scientist. AHD, TB, diagnostics. Runner, father, husband
Why don't we lose weight the way we expect when exercising- The Diagnostic Detective investigates
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The Case of the Vanishing Calorie Deficit
Exercise Is Great—So Why Doesn’t It Move the Scale like it Should?
open.substack.com
November 25, 2025 at 12:14 PM
Why don't we lose weight the way we expect when exercising- The Diagnostic Detective investigates
open.substack.com/pub/thediagn...
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Do Continuous Glucose Monitors make healthy people even more healthy. Or is it another fad? The Diagnostic Detective investigates
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Continuous Glucose Monitors for Wellness
Data Driven or a Test Looking for an Indication?
open.substack.com
November 17, 2025 at 9:35 AM
Do Continuous Glucose Monitors make healthy people even more healthy. Or is it another fad? The Diagnostic Detective investigates
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Publication of our protocol to test the safety of valganciclovir in patients with advanced HIV, CMV viraemia and no end organ disease. First Patient First Visit is imminent.
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Valganciclovir for cytomegalovirus viraemia in advanced HIV disease: a phase 2b randomized placebo-controlled trial of valganciclovir for cytomegalovirus viraemia in adults and adolescents with advanced HIV disease
Mortality among adults hospitalized with advanced HIV disease (AHD; CD4 <200 cells μl−1 or a WHO stage 3 or 4 disease) is >20%; there is an urgent need to evaluate strategies to reduce mortality within this extremely high-risk group. Approximately ...
pmc.ncbi.nlm.nih.gov
November 12, 2025 at 8:02 AM
Publication of our protocol to test the safety of valganciclovir in patients with advanced HIV, CMV viraemia and no end organ disease. First Patient First Visit is imminent.
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Does it help healthy people to take Vitamin D supplements? The Diagnostic Detective takes a look.
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Should Healthy People take Vitamin D supplements?
Who Really Needs the Sunshine Pill?
open.substack.com
November 11, 2025 at 7:16 AM
Does it help healthy people to take Vitamin D supplements? The Diagnostic Detective takes a look.
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@jaynesutherlandtb.bsky.social
Nice study but... I'd rather you chose a threshold with NPV of 99% and say X% had TB effectively ruled out. This would help me as a clinician. An NPV of 95% doesn't help, I am going to investigate with sputum etc. #blueintheface
academic.oup.com/cid/article/...
Nice study but... I'd rather you chose a threshold with NPV of 99% and say X% had TB effectively ruled out. This would help me as a clinician. An NPV of 95% doesn't help, I am going to investigate with sputum etc. #blueintheface
academic.oup.com/cid/article/...
Performance of 2 Finger-Stick Blood Tests to Triage Adults With Symptoms of Pulmonary Tuberculosis: A Prospective Multisite Diagnostic Accuracy Study
Two finger-stick blood tests to triage people with symptoms of pulmonary tuberculosis by measuring 3 host proteins (multibiomarker test) or 3 host RNA tran
academic.oup.com
November 7, 2025 at 12:59 PM
@jaynesutherlandtb.bsky.social
Nice study but... I'd rather you chose a threshold with NPV of 99% and say X% had TB effectively ruled out. This would help me as a clinician. An NPV of 95% doesn't help, I am going to investigate with sputum etc. #blueintheface
academic.oup.com/cid/article/...
Nice study but... I'd rather you chose a threshold with NPV of 99% and say X% had TB effectively ruled out. This would help me as a clinician. An NPV of 95% doesn't help, I am going to investigate with sputum etc. #blueintheface
academic.oup.com/cid/article/...
Reposted by Tom Boyles
"World's first potential trillionaire has killed 600,000 people, including 400,000 children" is the only headline that anyone should ever read about Elon Musk
One analytical model shows that, as of November 5th, the dismantling of U.S.A.I.D. has already caused the deaths of 600,000 people, two-thirds of them children. https://newyorkermag.visitlink.me/jUzNSc
The Shutdown of U.S.A.I.D. Has Already Killed Hundreds of Thousands
The short documentary “Rovina’s Choice” tells the story of what goes when aid goes.
newyorkermag.visitlink.me
November 7, 2025 at 1:33 AM
"World's first potential trillionaire has killed 600,000 people, including 400,000 children" is the only headline that anyone should ever read about Elon Musk
Do you need to drink 2 litres of water a day to stay healthy- or are you being duped? The Diagnostic Detective investigates
open.substack.com/pub/thediagn...
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Hydrated or Duped? Do You Need to Drink 2 Litres of Water a Day to Stay Healthy?
Does science really support the 2-litre rule, or is it bottled-up marketing?
open.substack.com
November 6, 2025 at 7:00 AM
Do you need to drink 2 litres of water a day to stay healthy- or are you being duped? The Diagnostic Detective investigates
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The Diagnostic Detective asks if the latest liquid biopsy for cancer is all that its cracked up to be. #GRAIL
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The Multi-Cancer Blood Test: A 1% Miracle or a $1,000 Illusion?
More data on the search for multi-cancer early detection tests
open.substack.com
October 27, 2025 at 12:55 PM
The Diagnostic Detective asks if the latest liquid biopsy for cancer is all that its cracked up to be. #GRAIL
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#Tuberculosis AI stethoscopes unimpressive in symptomatic patients. If they are ever useful (which I doubt), IMO it would be as a replacement for dCXR in active case finding. Is anyone doing that study?
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Diagnostic accuracy of a commercial AI digital stethoscope for diagnosis of TB
Improved TB screening requires non-invasive, low-cost, and rapid diagnostics. Digital stethoscopes utilising machine-learning approaches to analyse respiratory sounds have potential. We assessed accur...
pmc.ncbi.nlm.nih.gov
October 15, 2025 at 7:49 AM
#Tuberculosis AI stethoscopes unimpressive in symptomatic patients. If they are ever useful (which I doubt), IMO it would be as a replacement for dCXR in active case finding. Is anyone doing that study?
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Of course paracetamol doesn't cause autism but can the media stop saying 'not treating fever in pregnancy will lead to harm to the baby' without any EVIDENCE to back this up. It's conceivable that treating fever actually causes harm (this is a hypothesis not a statement of fact). #thenewsagents
September 24, 2025 at 9:12 AM
Of course paracetamol doesn't cause autism but can the media stop saying 'not treating fever in pregnancy will lead to harm to the baby' without any EVIDENCE to back this up. It's conceivable that treating fever actually causes harm (this is a hypothesis not a statement of fact). #thenewsagents
The Diagnostic Detective asks- should you take paracetamol (acetaminophen) for a fever? Will it help, will it hinder?
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Does paracetamol (acetaminophen) help you recover from a febrile illness?
Or is fever actually protective?
thediagnosticdetective.substack.com
September 17, 2025 at 9:34 AM
The Diagnostic Detective asks- should you take paracetamol (acetaminophen) for a fever? Will it help, will it hinder?
thediagnosticdetective.substack.com/p/does-parac...
thediagnosticdetective.substack.com/p/does-parac...
This is why indiscriminate use of CAB/RIL in Africa will be a disaster. INSTI resistance emerged in approximately 40%–70% of individuals experiencing VF. VF is rare in clinical trials (per diems), it will be much higher in standard of care settings in Africa. academic.oup.com/cid/article/...
Virologic Failure and Emergent Integrase Strand Transfer Inhibitor Drug Resistance With Long-Acting Cabotegravir for HIV Treatment: A Meta-analysis
Although 48-week virological failure rates were low, emergent integrase resistance among those failing injectable cabotegravir was common (41%–71%), and cr
academic.oup.com
September 17, 2025 at 7:52 AM
This is why indiscriminate use of CAB/RIL in Africa will be a disaster. INSTI resistance emerged in approximately 40%–70% of individuals experiencing VF. VF is rare in clinical trials (per diems), it will be much higher in standard of care settings in Africa. academic.oup.com/cid/article/...
I will be delighted to present a case from South Africa at this meeting
This RCPE symposium explores the intersections of pandemic recovery, humanitarian crises and health inequality.
Ideal for professionals in Infectious Diseases, Public Health, Global Health, and more.
Link to book: www.rcpe.ac.uk/events/infec... @tomboylesid.bsky.social @tomwingfield.bsky.social
Ideal for professionals in Infectious Diseases, Public Health, Global Health, and more.
Link to book: www.rcpe.ac.uk/events/infec... @tomboylesid.bsky.social @tomwingfield.bsky.social
September 16, 2025 at 7:06 AM
I will be delighted to present a case from South Africa at this meeting
Today the Diagnostic Detective asks- are cramps caused by dehydration and salt loss? Can you guess the answer?
thediagnosticdetective.substack.com/p/is-cramp-c...
thediagnosticdetective.substack.com/p/is-cramp-c...
Is cramp caused by dehydration and low salt levels?
Or is it a bit more complicated than that?
thediagnosticdetective.substack.com
September 11, 2025 at 12:42 PM
Today the Diagnostic Detective asks- are cramps caused by dehydration and salt loss? Can you guess the answer?
thediagnosticdetective.substack.com/p/is-cramp-c...
thediagnosticdetective.substack.com/p/is-cramp-c...
Another failed shortening study in patients with extensive disease (mostly). I am reminded of Einstein's definition of insanity. Shortening studies need to focus on patients with minimal disease. #tuberculosis - The Lancet Infectious Diseases www.thelancet.com/journals/lan...
A 3-month clofazimine–rifapentine-containing regimen for drug-susceptible tuberculosis versus standard of care (Clo-Fast): a randomised, open-label, phase 2c clinical trial
Although the trial was stopped early, we found that a 3-month regimen containing clofazimine
and rifapentine had 12-week culture conversion rates that did not differ statistically
from the standard of...
www.thelancet.com
September 9, 2025 at 8:19 AM
Another failed shortening study in patients with extensive disease (mostly). I am reminded of Einstein's definition of insanity. Shortening studies need to focus on patients with minimal disease. #tuberculosis - The Lancet Infectious Diseases www.thelancet.com/journals/lan...
The Diagnostic Detective asks 'Can your body become resistant to antibiotics?' open.substack.com/pub/thediagn...
Can your body become resistant to antibiotics?
The Lore
open.substack.com
September 1, 2025 at 10:19 AM
The Diagnostic Detective asks 'Can your body become resistant to antibiotics?' open.substack.com/pub/thediagn...
Can you prevent colds and 'flu with vitamin C. The Diagnostic Detective takes a look.
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Does vitamin C prevent common colds and 'flu?
Or is it another Old Wives Tale?
open.substack.com
August 7, 2025 at 8:54 AM
Can you prevent colds and 'flu with vitamin C. The Diagnostic Detective takes a look.
open.substack.com/pub/thediagn...
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Should you finish a course of antibiotics even if you feel better? The Diagnostic Detective takes a look, including the Special Case that is #Tuberculosis open.substack.com/pub/thediagn...
Should you finish a course of antibiotics, even if you feel better?
Will that cause or prevent antibiotic resistance?
open.substack.com
August 4, 2025 at 6:55 AM
Should you finish a course of antibiotics even if you feel better? The Diagnostic Detective takes a look, including the Special Case that is #Tuberculosis open.substack.com/pub/thediagn...
Free access to our article on the inclusion of LMICs in platform trials of bloodstream infections. SNAP in Johannesburg. @steventong.bsky.social @gurujosh.bsky.social
authors.elsevier.com/a/1lVzy,RGPg...
authors.elsevier.com/a/1lVzy,RGPg...
authors.elsevier.com
July 29, 2025 at 6:18 AM
Free access to our article on the inclusion of LMICs in platform trials of bloodstream infections. SNAP in Johannesburg. @steventong.bsky.social @gurujosh.bsky.social
authors.elsevier.com/a/1lVzy,RGPg...
authors.elsevier.com/a/1lVzy,RGPg...
The Diagnostic Detective looks at the evidence behind probiotics to restore gut health after a course of antibiotics. the results might surprise you.
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Do probiotics protect your digestive system from antibiotics?
Or do they cause more harm than good?
open.substack.com
July 28, 2025 at 2:08 PM
The Diagnostic Detective looks at the evidence behind probiotics to restore gut health after a course of antibiotics. the results might surprise you.
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Today the Diagnostic Detective moves to Medical Myths. Does running really ruin your knees? Or are knees like hearts; use them or lose them?https://thediagnosticdetective.substack.com/p/does-running-on-roads-ruin-your-knees
Does running on roads ruin your knees?
Or are joints more like hearts, use them or lose them?
thediagnosticdetective.substack.com
July 21, 2025 at 12:27 PM
Today the Diagnostic Detective moves to Medical Myths. Does running really ruin your knees? Or are knees like hearts; use them or lose them?https://thediagnosticdetective.substack.com/p/does-running-on-roads-ruin-your-knees
Conclusion says 'no significant difference' but it was a small study with 11%[95% CI –0·9 to 22·5] ARR. Surely a Bayesian approach would be more informative? I would use steroids in these patients - The Lancet Respiratory Medicine @lancetrespirmed.bsky.social www.thelancet.com/journals/lan...
Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC): a multicentre, double-blind, randomised controlled trial
In immunocompromised HIV-negative patients with P jirovecii pneumonia, adjunctive
corticosteroid treatment did not significantly decrease 28-day mortality.
www.thelancet.com
July 17, 2025 at 9:20 AM
Conclusion says 'no significant difference' but it was a small study with 11%[95% CI –0·9 to 22·5] ARR. Surely a Bayesian approach would be more informative? I would use steroids in these patients - The Lancet Respiratory Medicine @lancetrespirmed.bsky.social www.thelancet.com/journals/lan...
Reposted by Tom Boyles
“Now is the time to build – not dismantle.”
IAS’s Anna Grimsrud 🇿🇦 discussing the future of differentiated service delivery models, scale-up and PrEP integration. #IAS2025
IAS’s Anna Grimsrud 🇿🇦 discussing the future of differentiated service delivery models, scale-up and PrEP integration. #IAS2025
July 16, 2025 at 11:22 AM
“Now is the time to build – not dismantle.”
IAS’s Anna Grimsrud 🇿🇦 discussing the future of differentiated service delivery models, scale-up and PrEP integration. #IAS2025
IAS’s Anna Grimsrud 🇿🇦 discussing the future of differentiated service delivery models, scale-up and PrEP integration. #IAS2025
Reposted by Tom Boyles
SNAP trial update
➡️ The DSMC provided a recommendation to close the ADJUNCTIVE domain (Clindamycin), due to a statistical trigger for futility being met.
#IDsky
➡️ The DSMC provided a recommendation to close the ADJUNCTIVE domain (Clindamycin), due to a statistical trigger for futility being met.
#IDsky
July 16, 2025 at 11:07 AM
SNAP trial update
➡️ The DSMC provided a recommendation to close the ADJUNCTIVE domain (Clindamycin), due to a statistical trigger for futility being met.
#IDsky
➡️ The DSMC provided a recommendation to close the ADJUNCTIVE domain (Clindamycin), due to a statistical trigger for futility being met.
#IDsky
Can't believe the EMPIRICAL study showing reduced MORTALITY in kids with pneumonia given valganciclovir didn't get an oral! Come on #IAS2025. This is a VERY important finding.
July 16, 2025 at 8:21 AM
Can't believe the EMPIRICAL study showing reduced MORTALITY in kids with pneumonia given valganciclovir didn't get an oral! Come on #IAS2025. This is a VERY important finding.