Transmission to Dr. Holliday

[Sanstrom]

FORWARDED SECURED TRANSMISSION **ENCRYPTED*

FROM: Lisa Hardgrow RN
TO: Dr. Holliday

Dr. Holliday. The Mercy has finally entered communication range and is in receipt of all pending messages. We have also received Dr. Livingston's log which I've already forwarded as required and will attach here for your pleasure. I have not yet received an response from him in regards to your Welcome Letter.

Regards Lisa

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RESTRICTED ACCESS:
MEDICAL JOURNAL: Dr. David Livingston
Livingston General Intensive Care & Research Facility
Omicron Systems Report

***For Transmission When Possible***

826.491.12

**Open Log**
For the past year we have traveled throughout the Omicron systems doing what we can for those that live and work out in this mixed cauldron of Lives of the humanity containing a vase mixture of faction, culture, breed and species. All needing to get along because of a need to survive the harshest of elements and the occasional nomad.

The omicron systems have a high burden of end-stage disease, and age-standardized mortality for internal organ cirrhosis is alarming (for those aged over 15 cycles, the highest rates for males are 99·3 per 100 000 in Alpha, 94·9 per 100 000 in Pai, 82·6 per 100 000 in Epsilon, 56·7 per 100 000 in Zeta, and 48·7 per 100 000 in the Rho; whilst the highest rates for Females are 66·9 per 100 000 in Kappa, 52·4 per 100 000 in Gamma, 45·1 per 100 000 in Xi, 26·1 per 100 000 in the Russian Lost, and 25·5 per 100 000 in Nu).

The main aetiological factor is alcohol consumption, which in women accounts for almost three-quarters of deaths from organ cirrhosis in the various Omicron systems and in men for 70·8% of cirrhosis deaths in Epsilon, and around half of those in the remain systems.

These systems have some of the heaviest burdens of organ cirrhosis disease in the known systems.
What used to be known by old world verbiage as “Hepatitis viruses” of which we have long since eradicated also play an important part. Although data are incomplete due to weak or non-existent surveillance systems, adult prevalence of anti-hepatitis C virus (HCV) antibodies in the general population ranges from 1·3% in to 11·3% with a viremic rate between 69% and 39·2%,

and HBsAg seroprevalence ranges from 1·45% in Ukraine to 10·3%.

Hepatitis D virus (HDV) infection is also highly prevalent in various Omicron Systems and in some areas of the Sigma systems as well.

Although data are scarce, non-alcoholic fatty organ disease (NAFLD) probably constitutes an additional contributing factor, considering the progressive increase in overweight and obesity in recent years and the prevalence of metabolic risk factors and diabetes.

Lastly, the role of HIV infection cannot be overlooked; the epidemic Omicron systems still prevails in people who inject drugs (PWID) but the rate of viral transmission is growing and the seasonal labor migration from outlying systems is a contributing factor.

The interplay of these causes is complex. For instance, alcohol use and HCV infection act synergistically to provoke faster and more frequent progression of fibrosis, and the prevalence of metabolic syndrome and visceral adiposity increases among overweight and obese individuals who misuse alcohol, causing more prevalent and severe organ disease. HIV itself might contribute independently to liver disease, since advanced fibrosis can be found in HIV-infected patients without underlying viral hepatitis or alcohol misuse,

and individuals coinfected with hepatitis B virus (HBV) or HCV can have accelerated progression of fibrosis and an increased risk of hepatic decompensation and hepatocellular carcinoma.

So how can we reduce the burden of end-stage liver disease in eastern Europe and central Asia? At present, not enough is being done. In an analysis of the relation between the sale of different alcoholic beverages (beer, wine, vodka) and age-standardized mortality data for liver cirrhosis for 1970 to 2005, vodka alone seemed to be associated with liver cirrhosis mortality in the Russian Federation.

Making vodka less affordable through differential taxation could be important and has been an essential component of the alcohol policy in Russia in recent years, where official alcohol sales, especially for vodka, have steadily decreased.

Evidence exists for a decrease in mortality related to acute trauma, homicides, suicides, and car accidents as a result of these policies, but mortality from liver cirrhosis is unchanged in Belarus and has only decreased modestly in Russia, probably because of mortality related to cirrhosis already present before the policies were implemented. Furthermore, alcohol taxation might only mitigate the problem, because the demand for unrecorded, non-commercial alcohol can increase. Making efforts to raise public awareness of the risks of alcohol drinking and of surrogates for drinking, and trying to induce replacement of strong alcoholic drinks with those with less alcohol, is a possible way forward.

The only other action being taken is the introduction of HBV vaccination, although the inclusion of such vaccinations in national immunization programs obviously does not benefit individuals who are already infected. Public health campaigns should be enacted to invite the general population to get tested for HBsAg, and treatment should be provided to those in need before their liver disease becomes irreversible. Tenofovir and entecavir should be made available at affordable prices to countries in the region.

The HCV epidemics in each country must be stopped and particular attention should be given to PWID, in whom HCV prevalence is high. Increases in the availability of clean needles and syringes, and of opioid substitution therapy programs, together with access to potent and well tolerated interferon-free treatment regimens are vital. Obviously, reduction of drug prices will be essential. Similar measures would also limit the spread of HBV, HDV, and HIV in PWID.

Surveillance systems for chronic conditions should also be established to clarify the extent of the problem and to identify areas with higher prevalence of infection. Limitation of bureaucratic procedures to prescribe anti-HBV or anti-HCV drugs would also be useful.
Combating metabolic syndrome and NAFLD is also mandatory; limitation of unhealthy foods including red and processed meat and sugary drinks, increased physical activity, and improved sleep are difficult targets, which must nevertheless be pursued aggressively from childhood.

Reducing the burden of end-stage organ disease in the Omicron systems can be achieved only through the combined and concerted efforts of governments, civil society, the international health community, and pharmaceutical companies. It is crucial that the complexity of the problem is fully recognized and action is taken urgently.
**End Log**

Supplemental: Nancy. The captain has received word that our new ship is almost complete. So, I’ve asked her to go ahead and route us there where everyone can have some well-deserved R&R. Should any of the crew need help getting there family there, please do whatever is needed to make it happen. They deserve it and more. In addition, please insure please ensure each member of the crew (Including Medical, Crew, Scientist and Arbitrators) receive a 5,000-credit bonus before we reach or stopping point.

As always…Thanks…. David

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[i]Dr. David Livingston MD[i][/i][/i]