The John H. Stroger Jr. Hospital of Cook County (formerly Cook County Hospital) is a public hospital in Chicago, Illinois, United States. It is part of the Cook County Health and Hospital System, along with Provident Hospital of Cook County and several related centers, which provides public primary, specialty, and tertiary healthcare services to residents of Cook County, Illinois.Cook County Hospital was founded 1832, and became an innovative teaching hospital. In 2001-2002, it moved into new quarters adjacent to its historic Beaux-Arts complex in the Illinois Medical District and was renamed for hospital board president John Stroger Jr.
Streptococcus agalactiae, or Group B Streptococcus (GBS), is a historical cause of perinatal infections and neonatal sepsis. While routine screening programs in high-income countries have led to a steady decline in neonatal complications, GBS remains a frequent colonizer of the adult gastrointestinal and urogenital tracts. Over recent decades, the incidence of invasive GBS infections in nonpregnant adults has increased substantially, leading to significant morbidity and mortality. This shifting epidemiological landscape is further complicated by the troubling emergence of multidrug-resistant lineages and hypervirulent genomic clones, such as ST283, which demonstrate severe invasive potential and unique zoonotic transmission capabilities. Because collective data on this growing threat remains fragmented, this review synthesizes global literature on invasive adult GBS, encompassing its changing epidemiology, patient risk factors, and its expanding clinical spectrum. The primary objective is to collate updated evidence to raise clinical awareness, support antimicrobial stewardship, and direct future research toward effective preventive measures and strategies.
BACKGROUND:Older adults undergoing total joint arthroplasty (TJA) are particularly vulnerable to postoperative functional decline, yet the impact of anesthetic technique on recovery remains uncertain. This study examined whether spinal anesthesia (SA), compared with general anesthesia (GA), is associated with early functional decline and non-home discharge in geriatric patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS:We performed a retrospective cohort study using the 2021-2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥75 years undergoing THA or TKA were included. The primary outcome was functional status decline, defined as any reduction in activities of daily living independence from preoperative status to hospital discharge. The secondary outcome was discharge disposition, categorized as home versus non-home. Multivariable logistic regression was used to estimate adjusted ORs (aORs) for associations between anesthetic type and outcomes. RESULTS:The cohort included 62 338 cases (GA: 30 296; SA: 32 042). GA was associated with higher rates of functional decline (38.5% vs 30.2%; p<0.001) and non-home discharge (22.6% vs 11.0%; p<0.001). After adjustment, GA remained independently associated with increased odds of functional decline (aOR 1.32; 95% CI 1.28 to 1.37; p<0.001) and non-home discharge (aOR 1.70; 95% CI 1.63 to 1.78; p<0.001). Findings were consistent across THA and TKA subgroups. CONCLUSION:In patients aged 75 years or older undergoing elective total joint arthroplasty, general anesthesia was associated with significantly higher odds of early functional decline and discharge to a non-home setting compared with spinal anesthesia. These findings suggest that anesthetic choice may be a modifiable perioperative factor for optimizing recovery in geriatric total hip arthroplasty patients.
BACKGROUND AND AIM:Achalasia's insidious onset and nonspecific presentation contribute to diagnostic delays, often exceeding 20 months from symptom onset to confirmation. The four-domain CARS endoscopic score (Content, Anatomy, Resistance, Stasis) may expedite risk stratification. We performed a meta-analysis to assess diagnostic accuracy, interobserver reliability, and treatment-monitoring potential. METHODS:We searched PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov through June 2025. Study-level 2 × 2 contingency data were then synthesized using bivariate random-effects models to derive pooled sensitivity, specificity, positive predictive value, and negative predictive value, generate HSROC curves, and construct Fagan nomograms at 5% and 25% pre-test probabilities. RESULTS:We screened 49 studies and ultimately included five studies encompassing 1112 patients with a mean age of 54.5 years and overall achalasia prevalence of 31.7%. For a CARS threshold ≥ 4, pooled sensitivity was 0.73 (95% CI 0.69-0.78), specificity 1.00 (0.99-1.00), positive predictive value 0.99, and negative predictive value 0.88; employing a dual-threshold strategy (CARS = 0 to rule out; ≥ 4 to rule in) further improved sensitivity to 0.95 (0.92-0.98), specificity to 0.99 (0.97-1.00), positive predictive value to 0.99, and negative predictive value to 0.96. The HSROC AUC approached 0.99, and moreover interobserver agreement was almost perfect with a pooled Cohen's κ = 0.84 (95% CI 0.76-0.91). CONCLUSIONS:CARS reliably stratifies patients into low-risk (CARS = 0), moderate-risk (1-3), and high-risk (≥ 4) groups facilitating deferred testing, targeted manometry, or prompt invasive evaluation while demonstrating excellent interobserver agreement, underscoring its clinical utility. TRIAL REGISTRATION:PROSPERO number: CRD420251007005.
According to the United States Census Bureau, the population aged ≥ 65 years is projected to increase, and the percentage of office visits from older adults to specialist physicians, such as dermatologists, will also increase. Despite older adults comprising an estimated 40
A 46-year-old woman with a history of migraines presented with progressive left knee pain following routine exercise. Initial MRI demonstrated findings consistent with a ligamentous sprain, popliteus strain, proximal tibial marrow edema, and joint effusion, raising concern for a stress fracture and leading to conservative management. Over subsequent days, she developed worsening fatigue, malaise, exertional dyspnea, and hypoxia. Chest CT revealed bilateral ground-glass opacities without pulmonary embolism, and she was treated empirically for community-acquired pneumonia. An acute mid-soleal vein thrombosis was also identified, prompting initiation of anticoagulation. Despite therapy, her systemic symptoms progressed, with rising inflammatory markers. Follow-up MRI of the tibia revealed a new 9 mm lytic lesion with cortical breakthrough and periosteal reaction, concerning for malignancy. Extensive hematologic evaluation, including serum and urine immunofixation and skeletal survey, was unrevealing. Given persistent symptoms, recent travel, and exposure to building renovation, an infectious etiology was pursued. Broad testing was notable only for a positive Blastomyces urine antigen. Shortly thereafter, she developed characteristic cutaneous lesions, confirming disseminated blastomycosis with pulmonary, osseous, and cutaneous involvement. Treatment with intravenous amphotericin B resulted in clinical improvement. This case underscores the diagnostic challenges of osseous blastomycosis, which can mimic malignancy or bacterial osteomyelitis, and highlights the importance of maintaining a high index of suspicion for fungal infection in patients with unexplained bone lesions and systemic symptoms.
