Standing Orders Diabetes Mellitus Type Ii: Fill & Download for Free

To start - it would help if you define which type of diabetes you’re referring to; but okay, I’ll cover all of them. Next, we must define “cure” - the term is often mis-used, and that becomes the source of misunderstandings - so for my purposes here, I’m referring to “cure” as meaning, to find a way to alleviate all symptoms and the underlying cause so that NO further measures need ever be taken to control the underlying problem.There are two basic forms of diabetes - diabetes mellitus, and diabetes insipidus. Within those two categories, there are several sub-types of each. BOTH diseases involve the common symptoms of excessive urination, and extreme thirst due to dehydration. But for completely different reasons.Diabetes Insipidus (DI) is caused by either a loss of production and/or storage and/or secretion of vasopressin - a fluid-balancing hormone that controls the kidneys’ removal of fluids from the body via the bloodstream - or a failure of the kidneys to respond to it properly. Without proper vasopressin function, the kidneys screen out too much urine, dehydrating the patient. The urine lost is dilute and odourless - or insipid, hence the term “diabetes insipidus”. There are four types of diabetes insipidus, and each has its own cause. So for this family of diseases, four different cures would be needed.Central DI is caused by damage to the hypothalmus or pituitary gland, from something like an infection, a tumor, traumatic injury, or surgery. This condition is not something that can be cured; it’s more appropriate to talk about prevention. Of course… if we ever reach the stage of being able to re-grow organs (like the pituitary or hypothalmus), that would be the potential cure. Not likely in our lifetimes.Nephrogenic DI is caused when the kidneys fail to respond to vasopressin properly. This can occur for several reasons, which must be addressed individually. If it’s due to genetics, it’s not curable, only treatable, unless someone finds a way to permanently overcome the genetic defect - which is certainly beyond our capabilities now. Among the other known causes of nephrogenic diabetes insipidus are low potassium levels, high calcium levels, chronic kidney disease, urinary tract blockage, and certain medications. Again, most of these are more appropriately addressed as prevention issues. And of course… when we develop the ability to grow “replacement organs”… that would be an option for this disease. Again, not likely in our lifetimes.Dipsogenic diabetes insipidus is caused by a defect or damage to the thirst mechanism - located in the hypthalmus. So the answer here is the same as the answer for Central diabetes insipidus.Gestational diabetes insipidus is caused by pregnancy - in one of two ways (or both): either the placenta produces an enzyme that breaks down the mother’s vasopressin, or the mother produces excess prostaglandin, a chemical that reduces the kidneys’ sensitivity to vasopressin. This disease already has a cure - the birth of the baby. Though women that experience this during a pregnancy will likely experience it again if they become pregnant again.On to Diabetes Mellitus (DM). This is caused by one or both of two things: lack of insulin production, or lack of cellular response to insulin. It is classified as one of three diseases - DM Type 1, DM Type 2, and DM Type 3c - or T1, T2, and T3c respectively.T1 is caused by the total loss of insulin production due to the autoimmune destruction of the pancreatic endocrine beta cells - a tiny portion of the organ, about 2% of it in total. ALL T1s must inject insulin to survive. This is brought on by two things - the genetic markers for the condition, and an environmental “trigger” at a susceptible time in life. MANY people that carry the necessary genetic markers do NOT get the disease - though they may pass the genetic markers on to their children. A cure would require replacing the lost beta cells, and STOPPING the autoimmune attack on them, which resumes anytime functioning beta cells are introduced - as when transplants are done. So step one is to find a way to re-grow or replace those beta cells, and step two is to stop the autoimmune attack - which is genetic, and has already been initiated, making it a very tall order. Fortunately - there is research currently in process that seems to promise a stoppage to the immune attack… BUT… whether that would be a permanent stoppage, or one requiring repeated vaccinations remains to be seen. But this may occur in our lifetimes - or our childrens’.T3c is caused by partial or total loss of the endocrine pancreas (15% of the organ) due to an unrelated disease of the exocrine pancreas (the other 85% of it). This damage either reduces insulin production, or eliminates it entirely - leaving the patient with the need to inject exogenous insulin for the rest of their life, as a T1 must. Again, this is less a matter of a cure, and more a matter of prevention - but again, a cure for this would require a new organ, and alleviation of the causative disease of the exocrine pancreas (pancreatitis, pancreatic cancer, and cystic fibrosis are the most common causative diseases).Finally, T2 is caused - initially - by the entire body’s cells resisting the action of insulin - which is to transfer glucose (a simple form of sugar, and the only form our bodies use) from our bloodstreams (our bodies’ “delivery system”) into those cells - ALL of which NEED it for fuel. When the transfer is too slow and incomplete - too much glucose gets “left behind” in the bloodstream - causing all the symptoms of the disease, as well as all the damage to the tissues of the body, leading to all the nasty complications (this part is the same in T1s and T3cs). SO… the “cure” to T2 is to find a way to get the body’s cells to respond to insulin more efficiently. Currently, there are several medications that do this - to a small degree; but they don’t return the patient to normal insulin response levels, and they must be administered every day. Research into T2 is still at some very basic levels - a cure is not likely in our lifetimes, but perhaps in our childrens’.Of course… all of my observations about cures and methodologies for them are based on my limited knowledge of where the biochemical knowledge base stands now… I’m sure there are plenty of more knowledgeable experts that could give you a better rundown. But after reading the responses so far - I realised no one seems to have even addressed your actual query, so I thought I’d chime in.

The short answer is that there is no such thing as a daily value for sugars.The long answer requires some examination of what information the Nutrition Facts label actually conveys, and how this relates to claims regarding the toxicity of sugar. I have broken my response down into separate questions, meant to illuminate some of the evidence supporting my answer. The final section is where I actually get around to directly addressing the question.The question, as written, reveals considerable confusion about what constitutes a sugar and why high consumption of added sugars is harmful to health.In order to clarify as much as possible the issues at stake, I will separately address the Nutrition Label and the two links provided by the author of the question.What does the term "Sugars" mean on the FDA Nutrition Label?21 CFR 101.9(c)(6)(ii), which is the relevant part of the Code of Federal Regulations governing food and drugs, defines Sugars in the following way (selectively bolded for emphasis):(ii) "Sugars": A statement of the number of grams of sugars in a serving, except that label declaration of sugars content is not required for products that contain less than 1 gram of sugars in a serving if no claims are made about sweeteners, sugars, or sugar alcohol content. Except as provided for in paragraph (f) of this section, if a statement of the sugars content is not required and, as a result, not declared, the statement "Not a significant source of sugars" shall be placed at the bottom of the table of nutrient values in the same type size. Sugars shall be defined as the sum of all free mono- and disaccharides (such as glucose, fructose, lactose, and sucrose). Sugars content shall be indented and expressed to the nearest gram, except that if a serving contains less than 1 gram, the statement "Contains less then 1 gram" or "less than 1 gram" may be used as an alternative, and if the serving contains less than 0.5 gram, the content may be expressed as zero.Source: CFR - Code of Federal Regulations Title 21Note that no distinction is made between naturally occurring sugars and added sugars. This is because there is no chemical difference between naturally occurring mono- and disaccharides and added ones (however, the relative proportions of certain sugars can differ; I will address this in the third question). It is thus nonsensical to try to distinguish between sugars on the basis of whether or not they were added, when it is already in the final product. This brings me to my next point.Why is high consumption of added sugars harmful to health?This is an outrageously complicated question, but I will simply refer to the same Mayo Clinic source cited in the original question for a very brief summary (again, selectively bolded for emphasis):Eating too many foods with added sugar and solid fats sets the stage for potential health problems, such as:Poor nutrition. If you fill up on foods laden with added sugar, you may skimp on nutritious foods, which means you could miss out on important nutrients, vitamins and minerals. Regular soda plays an especially big role. It's easy to fill up on sweetened soft drinks and skip low-fat milk and even water — giving you lots of extra sugar and calories and no other nutritional value.Weight gain. There's usually no single cause for being overweight or obese. But added sugar may contribute to the problem. Many foods and beverages contain lots of sugar, making them more calorie-dense. When you eat foods that are sugar sweetened, it is easier to consume more calories than if the foods are unsweetened.Increased triglycerides. Triglycerides are a type of fat in the bloodstream and fat tissue. Eating an excessive amount of added sugar can increase triglyceride levels, which may increase your risk of heart disease.Tooth decay. All forms of sugar promote tooth decay by allowing bacteria to proliferate and grow. The more often and longer you snack on foods and beverages with either natural sugar or added sugar, the more likely you are to develop cavities, especially if you don't practice good oral hygiene.Source: Added sugar: Don't get sabotaged by sweetenersThe message here is that added sugars are not harmful due to any unique chemical properties, but rather that they tend to be in products that have extremely high calorie content, are easy to consume in large quantities, and are often found in products high in fats.Note also that added sugars are emphasized. Sugars occur naturally in foods, and recall that the FDA Nutrition Facts label does not distinguish between naturally occurring and added sugars, because it is not a chemically meaningful distinction.I want to be very clear: much of the prevailing nutritional advice concerning added sugars stems chiefly from the kinds of foods in which added sugars are found, not any unique property of added sugars themselves.But there is an emerging criticism of added sugars on the basis of a real, though subtle, chemical distinction. This is the issue in question in the 60 Minutes piece linked in the original question, and it is the final issue I will address on its own.Why do Lawrence Lessig and other researchers claim that sugar itself is actually harmful?The linked 60 Minutes segment mashes together a combination of factors, and presents them as a single push to decrease added sugar consumption. While the conclusion and the premises are independently valid, I'm not sure all the premises lead to the conclusion in the same way.The 60 Minutes piece highlights a few key potential harms of foods with high sugar content:1. Foods rich in added sugars are high in fructose, but lack dietary fiber (this is unique to added sugars).2. Foods rich in sugars are likely to elicit a strong insulin response, which may facilitate the growth of cancers (this is true of all foods containing glucose).3. Foods rich in sugars may be kind of addictive (this is unrelated to the point I want to make).Most of the naturally occurring sugars in a diet low in processed foods would likely come in the form of glucose, which is polymerized by plants into starch for storage (in animals, glycogen performs a similar function). Proper glucose metabolism notably involves release of the hormone insulin, and inadequate insulin response is the cause of diabetes mellitus and accounts for the need for diabetics to restrict sweets and starches in their diets.Source: Bender D.A., Mayes P.A. (2011). Chapter 14. Carbohydrates of Physiologic Significance. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.Added sugars are typically either sucrose (table sugar) or high fructose corn syrup (HFCS). Sucrose is a disaccharide of glucose and fructose, while HFCS is a blend of glucose and fructose monosaccharides, usually between 52-55% fructose.Fructose is normally encountered in nature in fruits. Lessig's claim regarding the harmful nature of added sugars centers on the disproportionately large amounts of fructose we ingest as a consequence of its presence in added sugars. Fructose is metabolized differently than glucose; most of it bypasses the key regulatory step of glucose metabolism. Fructose is primarily metabolized by an enzyme that does not respond to insulin, so high blood fructose also does not cause insulin secretion. Since insulin is an important hormone for nutritional balance, there is reason to believe that the body does not respond appropriately to high fructose consumption as it would to high glucose consumption (though the two monosaccharides have similar energy content).Source: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 24. Endocrine Functions of the Pancreas & Regulation of Carbohydrate Metabolism. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.Source: Welsh JA, Cunningham SA. The role of added sugars in pediatric obesity. Pediatr Clin North Am. 2011 Dec;58(6):1455-66, xi.Fructose is not inherently harmful; it exists abundantly in nature in fruits. But fruit also has considerable dietary fiber content. Fiber slows the absorption of sugars, a difference that is captured in the concept of the glycemic index (GI). The GI is a way of comparing the postprandial (after meal) blood glucose level that results from consumption of a certain food product relative to some baseline (usually white bread or pure glucose). Significantly, the GI of two food products can differ even if their glucose content is identical, due to differential absorption rates (attributable in part to dietary fiber content). While fructose is not the same as glucose, its absorption surely follows the same principles.Source: German M.S. (2011). Chapter 17. Pancreatic Hormones and Diabetes Mellitus. In D.G. Gardner, D. Shoback (Eds), Greenspan’s Basic & Clinical Endocrinology, 9e.The claims presented in the 60 Minutes piece regarding cancer hinge essentially on the notion of the glycemic index; a rapid influx of high glucose content elicits (in normal individuals) a robust insulin response. But the presence of high quantities of glucose is not unique to added sugars; if anything, naturally occurring sugars contain proportionately more glucose than added sugars. The key to reducing the size of insulin response is probably to absorb glucose more slowly, by increasing the amount of dietary fiber.In all of the emerging research discussed above, it is not the plain added sugar content of a food product that causes it to be harmful to health, and it is certainly not the overall sugar content. The cause of harm is best described as being related to the way the body absorbs and processes certain sugars from certain sources. As such, both the specific chemical content of the sugar (sucrose vs lactose vs starch, etc.) and the nature of the food product itself (cake vs sugary drink vs fruit vs yogurt) need to be taken into consideration.What is the takeaway? Why do FDA Nutrition Labels not give a %DV for sugars?There is increasing alarm in the scientific and nutritional community about the harmful health effects of added sugars. But it is important to understand why added sugars are thought to be harmful.Based on the information discussed above, the harmful health effects of added sugars can be attributed to two independent factors:1. Foods rich in added sugars tend to be low in fiber and are easy to consume in large quantities (e.g., sugary drinks).2. Added sugars are high in fructose, which escapes the tight metabolic and endocrine regulation to which glucose is subject.It is difficult or impossible to gauge the health effects of sugar consumption in isolation. Many of the benefits of reducing consumption of added sugars stems from the fact that foods high in added sugars tend to be unhealthful and are not nutritious (i.e., high added sugar content and lack of other nutrient content are correlated). If, hypothetically, a person were to add a lot of table sugar to a salad of fiber-rich leafy greens, it is not likely to be nearly as harmful as an equivalent amount of HFCS consumed in a sugary drink. There is also the separate claim advanced by Lessig and others that fructose, a significant component of most added sugars, is harmful in the quantities many Americans tend to consume.As it stands, FDA Nutrition Labels do not distinguish between added and naturally occurring sugars. "Sugars" refers to all free mono- and disaccharides in the final food product, many of which are naturally occurring. Yet certain researchers and advisory bodies have issued guidance on the amount of added sugars an individual should consume. Such guidance is based largely on assessment of the factors discussed above.Note that as it is currently designed, it is not possible for the FDA Nutrition Facts to adhere to such guidance, as there is no legal requirement for food manufacturers to identify the quantity of added sugars in a food product.There are a few ways I can think of to label sugars perceived as harmful:1. Create a separate item, "Added Sugars." This would be of dubious utility, since being added has no particular effect on the healthfulness of sugars. As described above, it is the properties of the foods in which added sugars tend to be abundant that makes them harmful, not the fact that the sugars have been added.2. Create a separate item, "Fructose." This could be assigned a %DV, based on available evidence. This could be useful, if the claims regarding the harmful effects of fructose are substantiated by continued research.3. Create a separate item, "Sugars:Fiber ratio." This could stand as an extremely crude indicator of the availability of sugars for absorption. I have no idea if there is any scientific basis favoring the utility of such a label.

In India, as per Merchant Shipping(Medical Examination Rules 2000[1] , as amended[2] )in accordance with the guidelines and rules as mentioned in ILO, MLC and STCW ,the following medical conditions generally render a person unfit for work at sea .Physical examination and laboratory tests to confirm the same are conducted by a DG Shipping approved Doctor .1. INFECTIOUS AND PARASITIC DISEASESAcquired Immune Deficiency Syndrome (AIDS)Enteritis, activeHepatitis, active or chronic, within 6 monthsSexually transmitted diseases, activeTuberculosis, active (The examining physician should take into account the advice of a chests physician, whether the lesion is fully healed and whether the patient has completed a full course of chemotheraphy. Cases where either one or both lungs have been seriously affected are rarely suitable for re-employment.)Typhoid, active or carrierMalariaLiceScabiesAny other infectious or parasitic diseases in its communicable or carrier state which would present a health hazard to other crew members or passengers through casual contract.2. MALIGNANT NEOPLASMSMalignancies of any type which could be considered to disqulify a seafarer from until evaluated,Any malignancy currently receiving treatment renders a person unfit for work at sea.(Exceptions may be appropriate for serving seafarers after treatment and without signs of recurrence.)3. IMMUNITY DISORDERSAIDSAdrenal insufficiency, uncontrolledDiabetes MellitusImmunosupressive therapyObesity, incapacitatingThyroid diseaseAbnormal liver or kidney functionsAny disease of the endocrine glands4. DISEASES OF THE BLOOD AND BLOOD FORMING ORGANS(Seafarers serving on broad chemical bulk carriers should have their blood tested every 12 months.The tests should include liver function tests and leukocyte count and be evaluated by a medical examiner.)Anaemia,symptomaticMyelodysplasiaSplenomegaly, symptomatic or not defindThere should be no significant disease of the haemopoetic system.5. MENTAL DISORDERSActive alcohol, substance abuse or dependence, if persistent and affecting health causing physical or behavioural disorder.Acute psychosis, whether organic, schizophrenic or any other listed in the International Classification of DiseasesPsychoneurosis major depression or maniaDementiaDepression, active, requiring medicationPersonality disorder, active (Observation of acute manifestations of a psychiatric disorder will indicate the need for psychiatric evaluation.)6. CONDITIONS OF THE NERVOUS SYSTEM AND SENSE ORGANSAtaxia, vertigo, activeConvulsive disorder, anyEpilepsyUnsteadiness of gaitImpairment of central nervous system function, secondary or active medical disorders (diabetes,toxic reaction, thyroid disorders)Post concussion syndrome, activeStrokeTremors, active, interfering with fine motor functionMigraine, frequent attacks causing incapacitySyncope and other disturbances of consciousnessMeniere's diseaseHearing loss, sudden or progressive, if sufficient to interfere with communication. (The use of a satisfactory hearing aid at work could be considered only in catering staff. The hearing aid should be sufficiently effective to allow communication at normal conversational levels of sound. Serving radio and engineering officers should be given audiometric examinations duringperiodic medical examinations.) (See also HEARING below)Epistaxis, frequentSinusitis, recurrent, draining7. CONDITIONS OF THE CARDIOVASCULAR SYSTEMConditions requiring anticoagulant medicationAortic aneurysm, Angina pectorisArrhythmiaBlood pressure, above 150/90 mmHg (in new candidates); 160/100 mmHg or above in seving seafarers under age 50 years; 175/100 mmHg in serving seafarers aged over 50 years; or blood pressure maintained below these levels by any antihypertension therapy without significant sideeffectsHypertension, treated, with, medication needing close monitoring Pacemaker dependent.Coronary bypass graftingCoronary angioplastyPacemaker-dependency, Heart valvular diseaseClaudicationMyocardial infarction, acuteOther vascular disease, symptomaticAny cerebrovascular accident, including transient ischaemic attacksGeneral cerebral arterosclerosis, including dementia and senilityVaricose veins, moderate degree, with recurrent symptoms; after operation, with symptoms; or not suitable for treatmentChronic varicose ulcerationsLacerant or persistent deep thrombosis or thrombophlebitisHaemorrhoids, prolapsed, bleeding causing symptoms (unoperated)Varicocele, with symptoms (unoperated)8. CONDITIONS OF THE RESPIRATORY SYSTEMBronchial Asthma (Acute/Chronic)Chronic bronchitis and /or emphysema: cases with recurring illness causing significant disabilityPneumothorax, spontaneous, within 12 monthsTumourPulmonory Koch's with less than 12 months treatmentCHEST - minimum 74 cm. (29 inches) with expansion range of 5cm. (2 inches).a. Chest should be well developed, well proportioned and there should be no evidence or history or Pulmonary Tuberculosis or other acute or chronic diseases of the lung, and/or the upper respiratory tract.b. An X-Ray/Screening examination of the chest will be carried out in all cases and defect, disability which disqualify a candidate shall be recorded.c. Candidate should be free from all diseases of respiratory system in all forms.d. There shall be no deformity of chest which may cause impediment to breathing.e. Lung Function : The resting respiratory rate should be below 20 per minute. The holdingtime should not be less than 30 seconds. The chest expansion should not be less than 5cm. (2 inches). Seafarers who measure poorly in these tests, to be subjected to a Vitalometry test for a definite indication of lung function.9. ORAL HEALTHMouth or gum infections, until treatedDental defects, until treated (seafarers should be dentally fit)Speech with impediments or loss of SpeechTEETH - The acceptance or rejection on account of loss or decay of teeth will depend on the relative position of the sound teeth and physical condition of the seafarer. He/She must have sufficient number of teeth to enable him/her to masticate efficiently and on no account would artificial dentures be acceptable for sufficient mastication. In order to assess whether a candidate has sufficient number of teeth to masticate effectively, the following guidelines are to be taken into consideration:a. Teeth which are not considered necessary for efficient mastication are allotted ONE POINT each and those essential TWO POINTS each. For instance, each incisor, canine, 1st and 2nd premolars will have have a value of one point provided their corresponding lower teeth are present.b. Each 1st and 2nd molar and well developed 3rd molar will have a value of two points provided they are in good opposition to corresponding teeth in the lower jaw. In the case the 3rd molar is not well developed, it will have a value of one point only.c. When all the 16 teeth are present in the upper jaw and in good functional opposition to corresponding teeth in the lower jaw, the total value will be 20 or 22 points according to whether the 3rd molars are well developed or not.d. The following teeth will be present in the upper jaw and in good functional opposition to corresponding teeth in the lower jaw:Any 4 of the 6 anterior; andAny 6 of the 10 posterior.e. Provided there are at least 14 dental points in the mouth, all these teeth must be sound and repairable. The minimum number of points required is 14.f. Seafarers with severe pyorrhea are to be rejected. If Pyorrhea is slight and teeth are otherwise sound, the seafarer may be accepted if, in the opinion of Dental doctor, he/she can be cured by normal dental treatment excluding extraction.10. CONDITIONS OF THE DIGESTIVE SYSTEMAbdominal LumpAbscess, perirectal or abdominal, activeAppendicitisBleeding, rectalCholelithiasis, symptomatic within 6 months/Gall stonesDiarrhoea, activeGastric or intestinal ulcerationHaematemesis, within 3 monthsHepatitis, active or chronic, within 6 monthsJaundice, currentPancreatitis, activePeptic ulcer disease in new candidates (In the case of serving seafarers, those with proven ulceration should not return to seafering until they are free of symptoms. There should be gastroscope of healing and the seafarer should have been on ordinary diet, without treatment, for atleast 6 months. Persons who have had gastro intestinal bleeding, perforation, recurrent peptic ulceration (despite treatment) or complications after surgery should be classified as unfit for work on ship.)Cirrhosis of the liver, where the condition is serious or progressive and/or where complications such as sesophageal varices or ascites are present.SpleenomegallyHepatomegallyFissure/Fistula in Ano (Unless operated)Abcesses (Unless operated)11. CONDITIONS OF THE GENITO URINARY SYSTEMAll cases of proteinuria, glycosuria, or other urinary abnormalitiesNephritis, acute, subacute, or chronicUrinary obstructions, if not remediableRenal or ureteric calculus, untreatedRemoval of kidney (Exceptions may be appropriate for serng seafarers.)Renal transplantRenal insufficiency, activeIncontinence of urine, if irremediableProstatism with retention, untreatedUrethral discharge, activeHydrocele, large and recurrenHernia-Direct & IndirectGynaecological conditions, acute or chronic, likely to cause trouble on the voyage or affect working capacity.12. PREGNANCY13. CONDITIONS OF THE SKINAll infections of the skin, until satisfactorily treatedAcute eczemaDermatoses, severe or uncontrolledManifestations of systemic disease (e.g. lupus, allergy).Carcinoma14. CONDITIONS OF THE MUSCULOSKELETAL SYSTEMSeafarers should have no defect of the musculoskeletal system that could interfere with the discharge of their duties (muscular power, balance, mobility and coordination should be unimpaired). A limb prosthesis would not be acceptable.15. HEARINGCandidates : unaided average threshold higher than 40db in both ears at 500, 1000, 2000 and 3000 hz and/or functional speech discrimination less than 90% at 55 db in both ears. Serving seafarers : unaided average threshold higher than 70 db in both ears at 500, 1000, 2000 and 3000 Hz and or functional speech discrimination less than 80% at 55 db in both ears.EARS:a. There should be no impaired hearing, discharge from or disease of either ear, unhealed perforation of the tympanic membrane or signs of acute or chronic supportive otitis media or evidence of radical or modified radical mastoid operation, and no congenital malformation of the ear.b. Should be able to hear a whisper at a distance of 5 meters on each side. No disease should be present. No hearing aid shall be permitted.16. EYESIGHTA. The standards for Pre-Sea medical examination are given below:1. There should not be any degree of squint or any morbid condition of either eye or the eyelids, pressure of trachome and iris complications sequela. Candidates must possess good binocular vision (fusion faculty and full field of vision in both eyes). Movement of the eyeballs must be full in all directions and the pupils should react normally to light and accommodation.2. Nautical Department (Deck Department) includes GP Crew:a. Distance vision (unaided 1.0 *(6/6) in better eye and 0.67*(6/9) in other eye; andb. Normal colour vision shall be tested by Ishihara test chart.3. Engine Department :a. Distance vision (unaided 0.5 *(6/12) in each eye or 0.61*(6/9) in better eye and 0.33 *(6/18) in other eye; andb. Normal colour vision shall be tested by Ishihara test chart4. Catering/Hospitality Department (including Bhandaries and Utility Hands):a. Distance vision (unaided 0.33 *(6/18) in each eye or 0.5*(6/12) in better eye and 0.25*(624) in other eye; andb. Normal colour vision shall be tested by Ishihara test chart.5. Radio Officers or Audio officers. Electrical Officer/Electronic Officer:a. Distance form vision (unaided 0.5 *(6/12) in each eye or 0.67*(6/9) in better eye and 0.33*(6/18) in other eye; andb. Normal colour vision shall be tested by Ishihara test chart.*Values given in Snellen Decimal Notation.B. The standards for Periodic medical examination are given in STCW 95, table B-1/9.Persons requiring the use of spectacles or contact lenses to perform duties should have a spare conveniently available on board the ship. Any need to wear visual aids to meet the required standards should be recorded on each certificate and endorsement issued. Eyes of seafarers should be free of disease. Any permanent or progressing debilitating pathology without recovery should be cause for determination of unfitness.17. SIGHT TESTSPART I1. Letter Test: The first test which the candidate shall have to undergo be the letter test conducted on Snellen's principle by means of sheets of letters. On each sheet the fifth, sixth and seventh lines correspond to standards 0.5 (Values given in Snellen Decimal Notation) (6/12), 0.67 (Values given in Snellen Decimal Notation) (6/9) and 1.0 (Values given in Snellen Decimal Notation) (6/6) respectively.2. Before the commencement of the test, the candidate who is not a new entrant shall advise the examiner whether or not he intends to use artificial aids to form vision.Such aids to form vision shall constitute of either spectacles or contact lenses. Tinted lenses shall not be permitted.3. Standard of vision required:a. Candidate will be tested in each eye separately;b. A candidate, other than a new entrant, who attempts the sight test without the use of aids to form vision shall be required to read down to and including the seventh line with the better eye and down to including the sixth line with the other eyec. A candidate other than a new entrant who attempts the sight test using aids to form vision shall be required:(i) with aids to form vision, to read correctly down to and including the seventh line with the better eye and down to and including the sixth line with the other eye; and(ii) without aids to form vision, to read correctly down to and including the fifth line with the better eye and down to and including and the third line with the other eye.d. A candidate who is a new entrant; i.e., a candidate who is going to serve in the deck department for the first time, shall be tested with each eye separately. He shall be required to read down to and including the seventh line with the better eye and to read down to and including the sixth line with the other eye. He shall also be required to read all letters in the seventh line with both the eyes. A new entrant shall not to be permitted to use aids to form vision.4. Method of testing:a. The test card shall be mounted at a convenient height, and shall be properly. Daylight shall not be used. The testing room shall be moderately lighted so that extreme between the test card and background is avoided.b. The candidate shall stand exactly 6 meters from the card facing it squarely. He shall then be required to read the letters on the sheet from left to right, beginning at the top and going downwards.c. Care shall be taken by varying the order of the test sheets to guard against the possibility of any deception on the part of the candidate.5. Failure:If the candidate fails to reach the standard required on the first sheet, he shall be tested with at least 4 sheets. If he fails to reach the standard in at least 3 of the 4 sheets the followingalternatives may be explained to him:a. He may break off the test and present himself for re-testing in not less than three months. In which case a certificate of failure shall be issued to him; orb. If he is not a new entrant and has not used aids to form vision at his first attempt, he may present himself for re-testing any time with artificial aids to form vision; orc. He may proceed to the lantern test. In this case, a record of all mistakes made in the letter test and all mistakes, if any, made in the lantern test shall be forwarded to the Chief Examiner, who shall decide whether the candidate has passed or failed in the sight test.PART II6. Lantern test-Apparatusa. A special lantern and a mirror shall be provided for this test. The test is to be conducted in a room so darkened as to exclude all light.b. The lantern shall be placed directly in front of the mirror, so that the front part of the lantern shall be exactly 3.05 metres from the mirror, and in such a position that the lights reflected in the mirror show clearly when viewed by the candidate on the left of the lantern.7.(1) A candidate other than a new entrant who has used artificial aids to form vision in theletter test may continue to use such aids in the lantern test.(2) Darkness adaptation: If a candidate makes mistakes at the beginning of the lantern test,he shall be kept in a completely or partially darkened room for at least a quarter, of an hour, and shall then begin the tests again(3) Method of testing:(a) The lantern supplied for the test shall be so constructed as to allow 1 large or 2 small lights to be visible, and is fitted with 9 glasses of 3 colours red, white and green. At the beginning of the test the candidate shall be shown a series of lights through the large apperture, and he shall be required to name the colours as they appear. Care shall be taken in showing the fact that this light is not a pure white. If a candidate makes a mistake in calling this light "red", aproper red light shall be shown immediately after and this attention directed to the differencebetween the two.(b) After a series of lights through the large aperture has been shown, 4 circuits and 1 broken circuit with the 2 small apertures shall be made with the candidate naming the colours of each set of 2 lights from left or right.8. Passing or failure:(1) If a candidate does not make any mistake in the lantern test after passing the letter test, he shall be deemed to have passed the whole test and the examiner shall issue a certificate to that effect.(2) If, with either the large aperture of the lantern, a candidate mistakes red or green or green or red, he shall be considered to have failed in the lantern test.(3) If a candidate makes any other mistakes with the lantern i.e. if he calls white "red" or red "white" or confuses green and white, his case shall be submitted to the Chief Examiner, and he shall be informed that the decision as to whether he is passed or failed, or must undergo a further test, shall be communicated to him in due course. Pending the receipt of the Chief Examiner's instructions, a candidate shall only be allowed to proceed with his examination for a Certificate of Competency on the express understanding that this examination will be cancelled in the event of failure in the sight tests. In every such case the candidate shall be notified by the examiner of his success or failure or that his case has been referred for special consideration.9. Retesting of unsuccessful candidate: A candidate who fails to pass the local lantern test shall not again be tested locally, unless the Chief Examiner directs that he may be so tested. The certificate issued to the candidate shall state whether or not he may be tested locally.18. HEIGHT AND WEIGHTThe minimum requirements in respect of new entrants are:Height 157 cm. (5'2")Weight 48kg (105lbs.)Weight to be proportionate to height and age, 10% acceptable, Average values are enclosed herewith. In case of Lakshadweep, Amindivi, the Andamans and Nicobar Islands, Gorkhas, Nepalese, Assamese and other hilly areas, including those from Nagaland, Mizoram, Meghalaya, Arunachal Pradesh, Manipur, Tripura, Garhwal, Sikkim, the candidate's height may be reduced by 5 cm. (2") and proportionately the minimum weight should be 45 kg. (100lbs.)Height without shoes : weight in indoor clothingFrom the recommendations of the Fogarty Center Conference on Obesity 1973 (Bray 1979) & based on the original Metropolitan Life Insurance Tables (1959).|Al-af |Footnotes[1] http://www.seafarers.edu.in/notices/ms_medical_2000.pdf[2] http://dgshipping.gov.in/WriteReadData/userfiles/file/ms_medical_exam_amendment_rules2016.pdf