Category: Nevin Manimala

Eur J Clin Microbiol Infect Dis. 2026 Feb 12. doi: 10.1007/s10096-026-05404-9. Online ahead of print.

ABSTRACT

PURPOSE : Chlamydia psittaci pneumonia (CPP) remains underdiagnosed due to nonspecific clinical manifestations. This study assessed the clinical utility of targeted next-generation sequencing (tNGS) in optimizing CPP diagnosis and antimicrobial stewardship, with a focus on empirical quinolone efficacy.

METHODS: We conducted a retrospective cohort study of 35 CPP patients (November 2022-October 2023) diagnosed by tNGS of respiratory specimens (8 sputum/27 bronchoalveolar lavage fluid [BALF]). Data included epidemiological history, laboratory findings, imaging features, therapeutic interventions, and clinical outcomes. Statistical comparisons between severe and non-severe CPP were performed using Student’s t-test and Mann-Whitney U tests.

RESULTS: Median diagnostic delay post-admission was 4 days (IQR:3-5). Fever predominated as initial presentation (97.1%), with 45.7% reporting avian contact. Leukocyte counts were normal/mildly elevated,, yet neutrophil ratio (83.86 ± 6.17%) and D-dimer (1.31 ± 0.86 mg/L) were notably increased. All patients showed elevated CRP (175.52 ± 87.62 mg/L) and ESR (70.00 ± 22.62 mm/h). Severe CPP cases (n = 8) exhibited higher CRP (p = 0.041) and procalcitonin (p = 0.013) than non-severe cases. Common comorbidities included hepatic dysfunction (68.6%) and pleural effusion (34.3%). Polymicrobial co-infections occurred more frequently in severe CPP cases than in non-severe cases (OR = 21.07, 95% CI:1.11-402.30). tNGS-guided diagnosis prompted antibiotic adjustment in 60.0% of patients (21/35) to targeted quinolone, tetracycline, or combination therapy. Clinical recovery was achieved in 97.1%, with 2.9% mortality.

CONCLUSIONS: tNGS enhances early CPP diagnosis and targeted antimicrobial adjustment. Quinolones demonstrate high efficacy as empirical treatment. The strong association between severe CPP and polymicrobial co-infections necessitates comprehensive pathogen screening. Study limitations include a single-center design and a small sample size, warranting validation through prospective multicenter studies.

PMID:41678126 | DOI:10.1007/s10096-026-05404-9

J Clin Sleep Med. 2026 Jan 5;22(1):10. doi: 10.1007/s44470-025-00014-2.

ABSTRACT

STUDY OBJECTIVES: Evidence of dairy’s association with sleep is limited. Therefore, we evaluated the association between dairy product consumption and self-reported and objective sleep outcomes in U.S. adults.

METHODS: Participants included 23,480 men and women (mean age 46.7 ± 17.3 years) from the 2005-2020 National Health and Nutrition Examination Survey. Dairy intake (total and sub-types) was estimated from two 24-h dietary recalls. We categorized average daily dairy intake as low, moderate, and high based on sex-specific tertiles. Sleep duration (< 7, 7-9 (ref.), ≥ 9 h/day) and trouble sleeping (yes/no) were obtained from questionnaires. Objective sleep measures were derived from accelerometer data in a subsample (n = 4,972). Survey-weighted multivariate logistic and linear regression were used to evaluate dairy intake in relation to self-reported and objective sleep outcomes, respectively.

RESULTS: Mean (SD) total dairy intake was 1.76 (1.34) cup-eq/day. High total dairy intake was associated with 16% and 23% lower odds of short and long sleep duration, respectively (all P-trend ≤ 0.01), and lower odds of trouble sleeping (OR_{high vs. low}=0.86; 95% CI 0.75-1.00; P-trend < 0.05). Similar associations between milk and sleep duration, and high-fat dairy and trouble sleeping were observed (all P-trend < 0.03). Moreover, high vs. low total dairy intake was associated with a higher sleep regularity index, and fermented dairy intake was associated with less variable sleep midpoint, and lower odds of poor sleep (all P-trend < 0.03).

CONCLUSIONS: Dairy consumption is associated with improved odds of adequate sleep, no trouble sleeping, and less variable sleep in U.S. adults. However, additional studies are warranted to assess causality. Current Knowledge/Study Rationale: Emerging research suggests that diet influences sleep health; however, evidence on the specific role of dairy products remains limited. We examined the association between dairy product consumption (total and subtypes) and both self-reported and objective sleep metrics in a nationally representative sample of U.S. adults. Study Impact: Dairy intake, especially of fermented dairy products, is associated with better sleep patterns, via improved odds of having adequate sleep, no trouble sleeping, and less sleep variability. Longitudinal studies and clinical interventions are needed to investigate causal associations and to clarify underlying mechanisms.

PMID:41678097 | DOI:10.1007/s44470-025-00014-2

J Clin Sleep Med. 2026 Feb 6;22(1):28. doi: 10.1007/s44470-025-00028-w.

NO ABSTRACT

PMID:41678095 | DOI:10.1007/s44470-025-00028-w

J Clin Sleep Med. 2025 Dec 22;22(1):7. doi: 10.1007/s44470-025-00019-x.

ABSTRACT

BACKGROUND: Adherence to positive airway pressure (PAP) therapy in obstructive sleep apnoea (OSA) remains suboptimal. Previous cognitive behavioural therapy (CBT) has relied on passive education approaches and has yielded mixed results.

OBJECTIVE: To evaluate whether personalised video footage showing one’s own sleep-disordered breathing events (Self-Viewing of Sleep Apnoea Videos, SVSV) improves PAP adherence.

METHODS: In this randomised controlled trial, 228 treatment-naïve patients with moderate to severe OSA were assigned to either the SVSV or standard CBT-only (control) group. All participants received standard CBT before PAP initiation. The SVSV group additionally viewed video footage of apnoeas from their own diagnostic polysomnography. The primary outcome was good adherence, defined as ≥ 4 h of sleep per night on ≥ 70% of nights for 90 days. Secondary outcomes included the number of days with adequate use, mean daily usage time, and apnoea-hypopnoea index (AHI) during PAP.

RESULTS: Good adherence was achieved in 89.5% of the SVSV and 78.1% of the control group (absolute difference, 11.4%; 95% confidence interval (CI), 1.94% to 20.86%). Compared with the control group, the SVSV group had more days with adequate usage (mean difference of 9.05 days; CI, 2.29 to 15.81) and longer daily usage (mean difference of 0.55 h; CI, 0.13 to 0.98). AHI during PAP therapy was similar between the two groups.

CONCLUSIONS: This study supports the clinical utility of patient-specific visual feedback to improve PAP adherence. SVSV-a simple, low-cost, and scalable strategy-resulted in a higher proportion of patients achieving good adherence and greater usage. 1. Current Knowledge/Study Rationale: Adherence to positive airway pressure therapy in obstructive sleep apnoea is often inadequate, limiting its therapeutic benefit. Previous educational approaches, including video-based cognitive behavioural therapy, have yielded inconsistent effects on adherence. 2. Study Impact: This prospective, randomised controlled trial shows that allowing patients to view video segments of their own sleep-disordered breathing events, extracted from diagnostic polysomnography, significantly improves positive airway pressure adherence. This personalised self-viewing intervention is simple, cost-effective, and easily integrated into existing clinical workflows, with particular value for underserved populations and individuals with limited health literacy.

PMID:41678091 | DOI:10.1007/s44470-025-00019-x

Invest New Drugs. 2026 Feb 12. doi: 10.1007/s10637-026-01602-6. Online ahead of print.

ABSTRACT

Cholangiocarcinoma (CCA) is a rare and aggressive biliary tract cancer with a poor prognosis. Despite recent advancements in molecularly targeted therapies for patients with IDH1 mutations and FGFR2 fusions, the efficacy of integrating these agents with first-line chemotherapy has not been established. This multicenter, Phase Ib dose de-escalation study, conducted prior to the establishment of chemoimmunotherapy as the standard first-line therapy, evaluated the safety and preliminary efficacy of combining ivosidenib or pemigatinib with gemcitabine and cisplatin in patients with advanced CCA. Eligible patients with no disease progression after three cycles of standard chemotherapy were assigned to receive either ivosidenib or pemigatinib based on their mutation status and chemotherapy. The primary endpoints were to evaluate safety, tolerability, the maximum tolerated dose, and the recommended Phase II dose. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and best response profile. The study opened in January 2020 and closed early in November 2022, enrolling eight patients – seven in the ivosidenib arm (Arm A) and one in the pemigatinib arm (Arm B). Enrollment in Arm B was constrained due to challenges in identifying FGFR2 fusion/rearrangement-positive patients in the first-line setting. Treatment-related toxicities of grade 3 or higher occurred in four patients (66.7%) in Arm A. Regarding efficacy, one patient (16.7%) in Arm A achieved a partial response, while the remaining five had stable disease, with a median progression-free survival (PFS) of 15.4 months in Arm A and a median overall survival (OS) of 22.9 months. Given the selection bias and small sample size, these efficacy analyses must be interpreted with caution. Adding ivosidenib to gemcitabine and cisplatin in this study demonstrated a challenging safety profile in advanced CCA. Further research and dose optimization are warranted to confirm these findings and optimize the integration of targeted therapies into first-line regimens.

PMID:41678089 | DOI:10.1007/s10637-026-01602-6

J Clin Sleep Med. 2026 Jan 29;22(1):22. doi: 10.1007/s44470-025-00009-z.

ABSTRACT

STUDY OBJECTIVES: For Veterans living with a serious mental illness (SMI), insomnia is prevalent and harmful. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment, but Veterans with SMI experience significant environmental, psychological, and systemic barriers to receiving and benefiting from it. There is limited clinical guidance on using CBT-I with Veterans with SMI. We developed provider guidelines and patient materials for conducting CBT-I when these barriers are present for people with SMI (CBT-I for SMI) and evaluated the acceptability and preliminary efficacy of CBT-I for SMI in an assessor-blind randomized controlled trial.

METHODS: Forty-seven Veterans with insomnia and SMI were randomized to either CBT-I for SMI (n = 26) or Health and Wellness (HW; n = 21), an active control condition. At baseline, post-treatment, and 3-month follow-up, participants completed: actigraphy and daily sleep diaries for two weeks and self-report measures of insomnia and functioning. At 3-month follow-up, participants completed satisfaction ratings of treatment.

RESULTS: CBT-I for SMI participants had high treatment satisfaction and attendance. At post, compared to HW, CBT-I caused statistically significantly greater reductions in diary-measured time-in-bed, increases in diary-measured sleep efficiency, reductions in actigraphy-measured time-in-bed and total sleep time, and improvements in self-reported insomnia severity and sleep-related functioning; relative to CBT-I, HW improved community participation.

CONCLUSIONS: CBT-I for SMI is acceptable to Veterans with SMI and improves sleep and functioning. Future research should examine how sleep mediates effective functional gains, identify how CBT-I could be integrated within recovery centers, and develop preventative interventions to curtail insomnia-associated functional decline. People with serious mental illnesses experience challenges to receiving and benefiting from Cognitive Behavioral Therapy for Insomnia. To support providers and patients, we developed guidelines and materials for navigating these challenges while conducting Cognitive Behavioral Therapy for Insomnia with people with serious mental illness. In the first study to compare Cognitive Behavioral Therapy for Insomnia conducted with our materials and guidelines to an active treatment control, we found that our guideline-led Cognitive Behavioral Therapy for Insomnia improved self-reported insomnia severity, sleep-related functioning, and actigraphy and diary-measured sleep of Veterans with serious mental illness and insomnia. Veterans with serious mental illness can participate in, derive satisfaction from, and benefit from Cognitive Behavioral Therapy for Insomnia when this treatment is appropriately tailored.

PMID:41678078 | DOI:10.1007/s44470-025-00009-z

J Clin Sleep Med. 2026 Feb 11;22(1):32. doi: 10.1007/s44470-025-00036-w.

ABSTRACT

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) impairs sleep and respiration, and sub-optimal adherence to its gold-standard CPAP therapy compels development of alternative approaches. This study investigates the effects of steam-assisted respiratory muscle training (RMT) on polysomnographic (PSG) outcomes in patients with OSA.

METHODS: In a 12-week open-label prospective pilot study, 60 working participants with mild to moderate OSA underwent individualized inspiratory and expiratory resistance training with adjunctive steam inhalation. PSG was conducted pre- and post-intervention. Primary outcomes included changes in respiratory indices (AHI, ODI₃, CT₉₀) and sleep quality metrics (sleep efficiency, WASO). Statistical analyses included the Shapiro-Wilk normality test, Paired T, Welch, or Wilcoxon comparing visits, Wilson CIs reporting responders, Mann-Whitney and Fisher assessing associations, regression predicting change, with significance set at p < 0.05.

RESULTS: Of 60 participants, 33 completed the study. Primary outcomes-respiratory indices and sleep continuity metrics-remained unchanged (all p > 0.05). Secondary analyses showed reduced REM latency, increased REM duration, and fewer periodic limb movements and arousal-related events (all p < 0.05). Regression analysis indicated that greater height and BMI were associated with fewer PLM, whereas larger waist circumference predicted more PLM.

DISCUSSION: Steam-assisted RMT did not significantly alter respiratory or sleep continuity indices but was associated with modest changes in REM architecture and limb movements. These findings should be interpreted cautiously, as exploratory observations in a non-controlled pilot setting. Larger randomized, sham-controlled trials with objective adherence monitoring are warranted to confirm these preliminary results.

PMID:41678040 | DOI:10.1007/s44470-025-00036-w

Intensive Care Med Exp. 2026 Feb 12;14(1):16. doi: 10.1186/s40635-026-00866-9.

ABSTRACT

BACKGROUND: Critically ill patients are at increased risk for cytomegalovirus (CMV) reactivation, which is associated with poorer clinical outcomes. However, little is known about the longitudinal viremia trajectories in this population.

METHODS: This retrospective single-center study was conducted in a medical ICU and included patients with CMV viremia ≥ 1000 International Units CMV-DNA per milliliter whole blood (IU/mL) treated between March 2014 and April 2021. Time-series clustering was applied to identify subgroups of patients with similar longitudinal viremia trajectories.

RESULTS: 82 patients were included in the final analysis. Time-series clustering identified three distinct clusters: (1) patients with initial high viremia (median 46,700 IU/mL), 94% receiving treatment and showing subsequent steep reduction of viremia; (2) patients with moderate viremia (median 2720 IU/mL) and subsequent increase in viral load, treated in 52%; and (3) patients with moderate viremia (median 3120 IU/mL), 63% receiving treatment and showing stable viral load in follow-up measurements. No significant differences were identified between the clusters with respect to patient characteristics, including underlying immunosuppression. With respect to disease severity, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score was highest in cluster 3 and among patients without follow-up CMV-DNA measurements (P = 0.029), while the Sequential Organ Failure Assessment (SOFA) score demonstrated a similar directional trend without reaching statistical significance. Survival differed significantly between the clusters in the Kaplan-Meier estimate (p = 0.008); however, absolute 1-year survival was low across all clusters (cluster 1: 0%, cluster 2: 33%, cluster 3: 32%, patients without follow-up CMV measurement: 14%; p = 0.062). Probable CMV pneumonia with respiratory symptoms and CMV-DNA detection in bronchoalveolar lavage fluid was the most common disease manifestation (cluster 1: 35%; cluster 2: 28%; cluster 3: 7.5%; patients without follow-up CMV measurement: 23%; p = 0.040).

CONCLUSIONS: In this hypothesis-generating study, time-series clustering analysis identified three subgroups with distinct longitudinal viremia trajectories which significantly differed in viral load, treatment decisions and survival over time. The diagnostic and therapeutic relevance of longitudinal CMV viremia trajectories and the optimal CMV-DNA threshold for treatment initiation in ICU patients remain undefined and might differ from other cohorts.

PMID:41678036 | DOI:10.1186/s40635-026-00866-9

Sports Med. 2026 Feb 12. doi: 10.1007/s40279-026-02399-3. Online ahead of print.

ABSTRACT

PURPOSE: Holistic Health and Fitness (H2F) is the United States Army’s largest force modernization initiative aimed at preserving combat power by optimizing soldier readiness across five domains: physical, mental, nutritional, sleep, and spiritual. At the core of this effort are H2F Performance Teams (HPTs): embedded, interdisciplinary subject matter experts, composed of strength and conditioning coaches, athletic trainers, physical and occupational therapists, registered dietitians, and mental readiness professionals. These teams operate within brigades to deliver proactive, preventive, and performance-enhancing interventions that reduce injury risk, accelerate rehabilitation, improve fitness and cognitive performance, and sustain deployability. This evaluation quantified the return on investment (ROI) of embedded HPTs across 56 matched active-duty brigades (28 HPT-resourced, 28 controls), encompassing over 1,000,000 soldiers from fiscal year (FY) 2019 through FY2023.

METHODS: A quasi-experimental, presence-based difference-in-differences framework estimated multiyear treatment effects for musculoskeletal injury (MSKI) referrals and profiles, behavioral health (BH) and substance abuse (SA) profiles, Army Combat Fitness Test (ACFT) pass/failure rates, Army Body Composition Program (BCP) noncompliance, and Rifle Marksmanship Qualification (RMQ). Outcome deltas were monetized using validated cost-per-case benchmarks from military/government reports and peer-reviewed studies. A 10,000-draw Monte Carlo simulation, incorporating triangular distributions and a ρ = 0.15 Gaussian copula, modeled fiscal uncertainty, interdomain dependency, and force-wide extrapolation.

RESULTS: Despite significantly worse baseline odds pre-resourcing, HPT brigades reversed all major readiness disadvantages by FY2023. MSKI referral odds declined 61% (odds ratio [OR] 1.16 → 0.45), SA profile odds dropped 79% (OR 1.92 → 0.41), and BH > 90-day profile odds fell 44% (OR 1.51 → 0.84). ACFT failure odds decreased 22% (OR 1.05 → 0.82), RMQ expert qualification odds increased 33% (OR 1.21 → 1.60), BCP failure odds decreased 12%, and RMQ failure odds declined 28%. Annually, per brigade, these effects translated to 1363 adverse events avoided and 37,484 duty days restored. Using domain-specific cost estimates, a 10,000-draw Monte Carlo simulation estimated mean annual cost avoidance of $14.06 M per brigade (95% CI $12.25-16.19 million), with 99.05% of draws exceeding a 4:1 ROI. Duty day restoration and expert RMQ gains added $10.38 million (95% CI $8.15-13.00 million) in readiness value. Combined, annual total economic value reached $24.44 million per brigade (ROI = 8.15:1; 95% CI 7.17-9.27), with force-wide extrapolation yielding $5.28 billion in annual total Army returns. Every $1 invested in HPTs returns $8.15 in value ($4.69 in cost avoidances and $3.46 in readiness improvements).

CONCLUSIONS: Embedded HPTs produce robust, statistically significant, multidomain improvements in readiness, performance, and cost efficiency. These estimates exclude long-horizon returns such as retention, disability deferral, or downstream system savings-suggesting total ROI is significantly underestimated. This study indicates HPTs are core readiness infrastructure. Their full-scale implementation is a strategic imperative for modernizing force sustainment and preserving the Army’s most critical asset: the soldier.

PMID:41678032 | DOI:10.1007/s40279-026-02399-3

J Relig Health. 2026 Feb 12. doi: 10.1007/s10943-026-02578-6. Online ahead of print.

ABSTRACT

Chronic diseases impose substantial suffering that often exceeds individuals’ capacity to maintain effective coping. Spiritual intelligence (SI) may play an integral role in shaping patients’ responses to chronic diseases and in their ability to adopt adaptive coping strategies. This study assessed the association between SI and coping strategies among a convenience sample of 185 adult patients with chronic diseases. A descriptive design was used, and participants completed the Spiritual Intelligence Self-Report Inventory (SISRI-24) and the Brief-COPE. The overall level of SI was moderate. A statistically significant positive correlation was found between SI and both problem-focused and emotion-focused coping strategies. Sociodemographic factors explained approximately 11.2% of the variance in SI. Patients with higher SI appear more capable of selecting adaptive coping strategies when dealing with chronic conditions.

PMID:41678020 | DOI:10.1007/s10943-026-02578-6