Relapsed Mpox Keratitis, St. Louis, Missouri, USA.

We describe a case of a 46-year-old man in Missouri, USA, with newly diagnosed advanced HIV and PCR-confirmed mpox keratitis. The keratitis initially resolved after intravenous tecovirimat and penicillin for suspected ocular syphilis coinfection. Despite a confirmatory negative PCR, he developed relapsed, ipsilateral PCR-positive keratitis and severe ocular mpox requiring corneal transplant.

Geographic disparities and predictors of COVID-19 vaccination in Missouri: a retrospective ecological study.

Background: Limited information is available on geographic disparities of COVID-19 vaccination in Missouri and yet this information is essential for guiding efforts to improve vaccination coverage. Therefore, the objectives of this study were to (a) investigate geographic disparities in the proportion of the population vaccinated against COVID-19 in Missouri and (b) identify socioeconomic and demographic predictors of the identified disparities. Methods: The COVID-19 vaccination data for time period January 1 to December 31, 2021 were obtained from the Missouri Department of Health. County-level data on socioeconomic and demographic factors were downloaded from the 2020 American Community Survey. Proportions of county population vaccinated against COVID-19 were computed and displayed on choropleth maps. Global ordinary least square regression model and local geographically weighted regression model were used to identify predictors of proportions of COVID-19 vaccinated population. Results: Counties located in eastern Missouri tended to have high proportions of COVID-19 vaccinated population while low proportions were observed in the southernmost part of the state. Counties with low proportions of population vaccinated against COVID-19 tended to have high percentages of Hispanic/Latino population (p = 0.046), individuals living below the poverty level (p = 0.049), and uninsured (p = 0.015) populations. The strength of association between proportion of COVID-19 vaccinated population and percentage of Hispanic/Latino population varied by geographic location. Conclusion: The study findings confirm geographic disparities of proportions of COVID-19 vaccinated population in Missouri. Study findings are useful for guiding programs geared at improving vaccination coverage and uptake by targeting resources to areas with low proportions of vaccinated individuals.

State licenses for medical marijuana dispensaries: neighborhood-level determinants of applicant quality in Missouri.

BACKGROUND: When state governments impose quotas on commercial marijuana licenses, regulatory commissions use an application process to assess the feasibility of prospective businesses. Decisions on license applications are often met with formal appeals and legal challenges from rejected applicants. Although prior research has examined substate disparities in the availability of marijuana dispensaries, less attention has been given to the quality of license applications. The present study analyzed the relationship between neighborhood-level characteristics and the quality of prospective dispensary businesses. METHODS: During Missouri's first applicant pool for medical marijuana dispensaries in 2019, a total of 606 census tracts contained the location site of at least one dispensary applicant. Using data from the Missouri Department of Health and Senior Services and the American Community Survey, fractional and binary logistic regression models were used to estimate the relationship between census-tract characteristics and application outcomes. RESULTS: License applications received higher evaluation scores when proposed dispensary sites were in census tracts with greater population densities and no majority in racial/ethnic composition. Census tracts with poorer socioeconomic conditions attracted a disproportionate share of low-scoring applicants from the bottom quartile of scores. These effects were stronger for certain application subsections, particularly those assessing the quality of an applicant's business plan and on-site security. CONCLUSIONS: Some communities tend to attract prospective license holders who possess better quality resources, business practices, and industry experience. State disparities in commercial licensing requirements and application processes may lead to the inequities in legal product access found in some prior studies.

A Retrospective Analysis of Hyperlipidemia and COVID-19 Outcomes Investigated in a Rural Midwestern Population.

Background COVID-19 is a respiratory disease caused by SARS-CoV-2, a coronavirus discovered in 2019. Its impact on the world continues to be studied due to the significant death toll of the disease. As the COVID-19 pandemic remains ongoing, examining the association of COVID-19 with comorbidities and resulting mortality is necessary. This study focuses on population health outcomes with COVID-19 infection and hyperlipidemia (total cholesterol greater than or equal to 200 mg/dL) as a comorbidity, including potential associations with age and sex. Methods As a retrospective analytical study, patients were divided into three populations based on COVID-19 and/or hyperlipidemia based on the International Classification of Diseases, Tenth Edition (ICD-10) codes reported in the electronic medical record system at Freeman Health System (FHS) in Southwest Missouri from April 1, 2020, to December 31, 2021. Wald's methods and two sample proportion summary hypotheses with confidence intervals (CIs) were used for comparison. The populations were subdivided and analyzed for age and sex differences. Results Patients with both COVID-19 and hyperlipidemia had a higher mortality rate than patients with COVID-19 and without hyperlipidemia and patients with hyperlipidemia and without COVID-19; patients with COVID-19 and without hyperlipidemia had a higher mortality rate than patients with hyperlipidemia and without COVID-19. All comparisons across these populations were statistically significant (p-value < 0.05). While increased age was associated with increased mortality in all groups, sex was not predictive in this regard. Conclusion Our study provides insights into variables affecting COVID-19 outcomes in a rural Midwestern population by showing how the comorbidity hyperlipidemia contributes to increased mortality.

The distribution of triatomine (Hemiptera: Reduviidae) vectors of Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) in Illinois and Missouri: historical records and specimen submissions from community science programs.

Triatomine species (kissing bugs) infected with Trypanosoma cruzi are found across the southern United States. The northern limits of Trypanosoma cruzi infected kissing bugs are less understood. The objective of this work was to describe the locations of kissing bugs from Illinois and Missouri based on historical records, submissions to Texas A&M University's (TAMU) Kissing Bug Community Science Program and the Centers for Disease Control and Prevention (CDC), and records from online platforms (iNaturalist, BugGuide, and GBIF) up to and including 2022. A total of 228 records were discovered, including 186 from historical or observation platforms and 42 specimens submitted to TAMU or CDC. Species included Triatoma sanguisuga (221 total records, 9 nymphs) and Triatoma lecticularia (7 records). Notably, nearly all (24/26) records submitted to TAMU were collected indoors. Twelve of the 30 (40%) specimens tested were positive for the presence of T. cruzi, including parasite discrete taxonomic units TcI and TcIV. One triatomine sample had been found in a bed feeding on the submitter; this bug was positive for T. cruzi and had evidence of human blood in its gut. Records suggest a ubiquitous distribution in Missouri and potentially to the northernmost border in Illinois. Further investigations into triatomine distribution and infection status are needed within states assumed to be northern limits in order to create public health and veterinary health messaging and baseline distributional maps from which to measure future range shifts in relation to a changing climate.

Spatial Epidemiologic Analysis and Risk Factors for Nontuberculous Mycobacteria Infections, Missouri, USA, 2008-2019.

Nontuberculous mycobacteria (NTM) infections are caused by environmental exposure. We describe spatial distribution of NTM infections and associations with sociodemographic factors and flooding in Missouri, USA. Our retrospective analysis of mycobacterial cultures reported to the Missouri Department of Health and Social Services surveillance system during January 1, 2008-December 31, 2019, detected geographic clusters of infection. Multilevel Poisson regression quantified small-area geographic variations and identified characteristics associated with risk for infection. Median county-level NTM infection rate was 66.33 (interquartile range 51-91)/100,000 persons. Risk of clustering was significantly higher in rural areas (rate ratio 2.82, 95% CI 1.90-4.19) and in counties with >5 floodings per year versus no flooding (rate ratio 1.38, 95% CI 1.26-1.52). Higher risk for NTM infection was associated with older age, rurality, and more flooding. Clinicians and public health professionals should be aware of increased risk for NTM infections, especially in similar environments.

Farm impacts of the 2019 Missouri River floods and economic valuation of flood risk reduction.

The 2019 Missouri River flood caused billions of dollars in damage to businesses, homes, and public infrastructure. Yet little is known about the farm-level effects of this event and farmers' perceptions of its causes. This study reports on the operational and financial setbacks farmers sustained because of the 2019 floods, as well as on their beliefs on the causes of these floods. It further explores farmers' willingness to pay (WTP) to avoid flood risks and the factors that condition it. The empirical application focuses on a sample of approximately 700 Missouri farmers operating near the Missouri River. Results show that yield loss, loss of growing crops, and inability to plant crops were the three most important consequences of flooding. Nearly 40% of the flood-affected farmers reported financial losses of $100,000 or more. Most respondents identified government decision makers as the cause of the 2019 floods, and many believe that government should prioritize flood control over other benefits (recreation and fish and wildlife habitat) the Missouri River system provides. The WTP results show that less than half of the surveyed farmers were willing to pay to avoid flood risks, with an average WTP estimated at $3 per $10,000 value of agricultural land. Subjective but not objective risk exposure influences WTP for flood risk reduction. Other important determinants of WTP are risk aversion, disutility from flood risks, and respondents' age, income, and education. Directions for policy to improve flood risk management in the Missouri River Basin are discussed.

Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients.

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.

Susceptibility of Pallid Sturgeon to viral hemorrhagic septicemia virus genotype IVb.

OBJECTIVE: Viral hemorrhagic septicemia virus (VHSV) is an aquatic rhabdovirus causing severe disease in freshwater and saltwater fish species. The susceptibility of endangered Pallid Sturgeon Scaphirhynchus albus to VHSV genotype IVb (VHSV-IVb) infection was investigated. METHODS: An in vitro assessment using two Pallid Sturgeon cell lines derived from skin and spleen tissue and in vivo evaluation of juvenile Pallid Sturgeon after exposure to VHSV-IVb were performed. RESULT: Plaque assay and RT-PCR results confirmed VHSV-IVb replication in Pallid Sturgeon cell lines. Sturgeon were also susceptible to VHSV-IVb infection after immersion and injection exposures during laboratory experiments. However, after widespread mortality occurred in all treatment groups, including negative control fish, it was determined that the Pallid Sturgeon stock fish were infected with Missouri River sturgeon iridovirus (MRSIV) prior to experimental challenge. Nevertheless, mortalities were equal or higher among VHSV-exposed fish than among negative controls (MRSIV infected), and histopathological assessments indicated reduced hematopoietic cells in spleen and kidney tissues and hemorrhage in the gastrointestinal organs only in fish from the VHSV treatment. CONCLUSION: These results indicate that Pallid Sturgeon is a susceptible host for VHSV-IVb, but the degree of pathogenicity was confounded by the underlying MRSIV infection. Research comparing susceptibility of specific pathogen-free and MRSIV-infected fish to VHSV-IVb is needed to accurately assess the vulnerability of Pallid Sturgeon to VHSV-IVb.

One Health Approach for Reporting Veterinary Carbapenem-Resistant Enterobacterales and Other Bacteria of Public Health Concern.

A carbapenem-resistant Enterobacterales outbreak at a veterinary teaching hospital in the United States increased urgency for improved communication among diagnostic laboratories, public health authorities, veterinarians, and pet owners. Kansas State University, University of Missouri, Kansas Department of Health and Environment, and Veterinary Laboratory Investigation and Response Network created a surveillance, storage, and reporting protocol for veterinary antimicrobial-resistant bacteria; determined frequency of those bacteria in companion animals during 2018-2021; and created educational flyers for veterinarians and pet owners. We recommend a One Health strategy to create efficient surveillance programs to identify and report antimicrobial-resistant bacteria and educate veterinarians and pet owners about transmission risks.

Using the Gut Microbiome to Assess Stocking Efforts of the Endangered Pallid Sturgeon, Scaphirhynchus albus.

The endangered Pallid Sturgeon, Scaphirhynchus albus, has been actively managed to prevent population declines, including stocking of hatchery-raised fish. The gut microbiome plays an innate role in an organism's absorption of nutrients by increasing nutrient availability and can provide new insights for Pallid Sturgeon management. In this study, the Pallid Sturgeon's microbiome is dominated by the phyla Proteobacteria, Firmicutes, Actinobacteria and Fusobacteria. It was also determined that the gut bacterial diversity in hatchery-raised Pallid Sturgeon was not significantly different from wild Pallid Sturgeon, supporting that hatchery-raised Pallid Sturgeon are transitioning effectively to wild diets. There is also a high degree of intraspecific variation in the bacterial and eukaryotic sequences amongst individual Pallid Sturgeon microbiomes, suggesting the Pallid Sturgeon may be omnivorous. This study demonstrated that genetic markers may be used to effectively describe the dietary requirements for wild Pallid Sturgeon and provides the first genetic evidence that Pallid Sturgeons are effectively transitioning from hatchery-raised environments to the wild.

Dietary exposure assessment of selected trace elements in eleven commercial fish species from the Missouri market.

Fish is an important source of proteins, vitamins, minerals, and polyunsaturated fatty acids for nutrition adequacy. However, fish is a major link to dietary metal exposure in humans. This study describes the content of eight trace elements (As, Cd, Cr, Cu, Ni, Pb, Zn, and Hg) in eleven commercial fish species from the Missouri market and evaluated the health risks of fish muscle consumption in the adult population. Total mercury (THg) in muscle was quantified by AAS and ICP-OES was used for other elements. The recovery rates of elements from DOLT-5 reference material ranged from 83% to 106%. Of all the 239 fish samples analyzed, trace element concentrations (mg/kg wet weight) in muscle were in the following ranges: As < LOD-17.5; Cd: 0.016-0.27; Cr: 0.023-0.63; Cu: 0.034-1.06; Ni:

A scientific mind embraces medicine: Donald Lindberg's education and early career.

As a young pathologist, Donald A.B. Lindberg, M.D., tirelessly sought scientific solutions to clinical and research problems. Directing several clinical laboratories at the University of Missouri in Columbia, Dr. Lindberg developed the world's first computerized laboratory information system, speeding analysis and reporting. He directed his team in building computer systems to help clinicians retrieve medical knowledge, enable patients to find information about personal or family health issues, and provide expert automated assistance to physicians in reaching differential diagnoses outside their specialties. Developing superior functionalities with the limited information technologies of the time, Dr. Lindberg's pioneering work in Columbia foreshadowed his subsequent inspired leadership as Director of the United States National Library of Medicine.

Geographic disparities and predictors of COVID-19 hospitalization risks in the St. Louis Area, Missouri (USA).

BACKGROUND: There is evidence of geographic disparities in COVID-19 hospitalization risks that, if identified, could guide control efforts. Therefore, the objective of this study was to investigate Zip Code Tabulation Area (ZCTA)-level geographic disparities and identify predictors of COVID-19 hospitalization risks in the St. Louis area. METHODS: Hospitalization data for COVID-19 and several chronic diseases were obtained from the Missouri Hospital Association. ZCTA-level data on socioeconomic and demographic factors were obtained from the American Community Survey. Geographic disparities in distribution of COVID-19 age-adjusted hospitalization risks, socioeconomic and demographic factors as well as chronic disease risks were investigated using choropleth maps. Predictors of ZCTA-level COVID-19 hospitalization risks were investigated using global negative binomial and local geographically weighted negative binomial models. RESULTS: COVID-19 hospitalization risks were significantly higher in ZCTAs with high diabetes hospitalization risks (p < 0.0001), COVID-19 risks (p < 0.0001), black population (p = 0.0416), and populations with some college education (p = 0.0005). The associations between COVID-19 hospitalization risks and the first three predictors varied by geographic location. CONCLUSIONS: There is evidence of geographic disparities in COVID-19 hospitalization risks that are driven by differences in socioeconomic, demographic and health-related factors. The impacts of these factors vary by geographical location implying that a 'one-size-fits-all' approach may not be appropriate for management and control. Using both global and local models leads to a better understanding of geographic disparities. These findings are useful for informing health planning to identify geographic areas likely to have high numbers of individuals needing hospitalization as well as guiding vaccination efforts.

A Scientific Mind Embraces Medicine: Donald Lindberg's Education and Early Career.

As a young pathologist, Donald A.B. Lindberg, M.D., tirelessly sought scientific solutions to clinical and research problems. Directing several clinical laboratories at the University of Missouri in Columbia, Dr. Lindberg developed the world's first computerized laboratory information system, speeding analysis and reporting. He directed his team in building computer systems to help clinicians retrieve medical knowledge, enable patients to find information about personal or family health issues, and provide expert automated assistance to physicians in reaching differential diagnoses outside their specialties. Developing superior functionalities with the limited information technologies of the time, Dr. Lindberg's pioneering work in Columbia foreshadowed his subsequent inspired leadership as Director of the United States National Library of Medicine.

Concentration dataset of 8 selected trace elements in cultured rainbow trout (Oncorhynchus mykiss) and dietary exposure risks in the Missouri adult population.

Aquaculture contributes to the global animal protein supply and the prevention of malnutrition and diet-related diseases (FAO (Food and Agriculture Organization of the United Nations); Fiorella et al., 2021). In particular, fish is a significant source of animal protein, fatty acids (e.g., docosahexaenoic acid, eicosapentaenoic acid), vitamins, and essential trace elements in the human diet. Nonetheless, fish bioaccumulates metals from their diet and habitat. This data article includes information on the concentrations of 4 essential and 4 non-essential trace elements in cultured rainbow trout (Oncorhynchus mykiss) and the human health risks through fish consumption in the adult population. Concentrations of four essential (Cr, Cu, Ni, and Zn) and four non-essential (As, Cd, Pb, and Hg) elements were quantified in ninety-one O. mykiss samples from an in-door production system. Total mercury (THg) levels in samples were determined by AAS, and other analyzed trace elements were measured by ICP-OES after microwave-assisted acid digestion. The highest concentrations of metals/metalloid (mg/kg wet weight) in fish muscle were Cr (0.44), Cu (4.21), Ni (1.01), As (0.47), Cd (0.045), Pb (0.65), THg (0.029), and Zn (6.21). The average concentrations of Cr and Pb exceeded their respective maximum limit. In most cases, median metal concentrations significantly (p < 0.05) differed across the fish size groups (small: 264-295 mm; medium: 300-395 mm; and large: 400-552 mm). The median concentrations of Cd, Zn, and THg in the large size group differed significantly (p < 0.05) between genders. The estimated weekly intake values of quantified elements from muscle were below the provisional tolerable weekly intakes. Non-carcinogenic risk assessment in adult consumers, being below one (THQ ≤ 1; and TTHQ ≤ 1), indicated an insignificant health hazard. The estimated incremental and cumulative cancer risks in the adult class through Cr, As, Ni, and Pb exposure were greater than the benchmark (10-5). Accordingly, high dietary intake of metals/metalloid from cultured O. mykiss posed a risk of carcinogenesis in the adult risk class.

First Record of the Asian Longhorned Tick Haemaphysalis longicornis in Missouri.

The Asian longhorned tick, Haemaphysalis longicornis, is an invasive species, originally from eastern Asia, and was first reported in the USA in New Jersey. It is now reported in several eastern states. In 2018, researchers reported H. longicornis in northwest Arkansas (Benton County). This tick species is a proven vector of livestock and human diseases, which prompted the current survey of ticks in southwest Missouri. A tick drag in Greene County, Missouri, produced 2 H. longicornis nymphs on June 9, 2021. This is the first report of this species for both the state and county.