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Using this extrapolation, one may estimate the annual rate to be between one and two per cent. Risk of subtle impairment of performance Data to estimate this prevalence are rather difficult to obtain and frequently not robust, but from the study of Pramming (1991), one may postulate, using the work of McLeod (1993), that the rate of mild hypoglycaemia may be 50 per cent less in Type 2 diabetics than Type 1. The lower rate of hypoglycaemia in Type 2 diabetes has been confirmed by Holman et al. This differing rate of hypoglycaemia between Type 1 and Type 2 diabetes may be due in part to the preservation of the glucose counter regulation mechanism which protects against progression to severe hypoglycaemia. In contrast to Type 1 diabetes, the rate of substantive hypoglycaemia in Type 2 diabetes is lower, ranging from 2. As mentioned, these data are from hospital populations and in the pilot population, highly committed and well educated in diabetes, it is likely, using careful selection criteria, that the rate may be lower. Selection criteria On the basis of the literature review it would be appropriate to consider only Type 2 insulin-treated diabetes with its lower prevalence of hypoglycaemia. The individual should have good diabetic education and be well motivated to achieve good control. In addition the individual should be regularly monitored by a diabetologist to exclude any complications. Risk benefit analysis the benefit to aviation of introducing this protocol would be to help maintain a high level of aviation experience on the flight deck, with minimal risk to flight safety; many of these pilots have a wealth of experience, as the majority of Type 2 diabetics do not present with failure to respond to oral hypoglycaemic agents until they are between 40 and 50 years old. Pilots in this age group usually have extensive flying experience and are likely to exhibit more mature judgement skills than their more junior colleagues. By selecting Type 2 diabetics and returning them to the flight deck with a multi-crew limitation, the risk is further reduced due to the incapacitation training that commercial pilots are required to undergo when operating on multi-crew flight decks. This risk can be further mitigated by a stipulation that the pilot must inform his colleagues on the flight deck of the nature of his multi-crew endorsement and instruct them in actions should mild or severe hypoglycaemic events occur. In any long-haul operation there is ample time to check blood sugar levels at regular intervals and the availability of carbohydrate is not a problem. In a short-haul operation it is unlikely that the blood sugar will change dramatically over a one-to-two-hour period but at the midpoint of the flight, monitoring should be carried out. Provided these interventions are given adequate attention, this approach has potential benefit to the aviation industry as well as to the pilots concerned.

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Nephrocalcinosis is characterised by deposition of calcium salt at the following locations except: A. Out of various histologic types of renal cell carcinoma, the following type has worst prognosis: A. Schistosomiasis of the urinary bladder is implicated in the following type of bladder tumour: A. Collapsing sclerosis is a feature of following type of primary glomerular disease: A. Which of the following is the histologic hallmark for the diagnosis of rapidly progressive glomerulonephritis M/E the seminiferous tubules are formed of a lamellar connective tissue membrane and contain several layers of cells. Spermatogonia or germ cells which produce spermatocytes (primary and secondary), spermatids and mature spermatozoa. Sertoli cells which are larger and act as supportive cells to germ cells, produce mainly androgen (testosterone) and little oestrogen. The fbrovascular stroma present between the seminiferous tubules contains varying number of interstitial cells of Leydig. These cells are the main source of testosterone and other androgenic hormones in males. In 70% of cases, the undescended testis lies in the inguinal ring, in 25% in the abdomen and, in the remaining 5%, it may be present at other sites along its descent from intra-abdominal location to the scrotal sac. Seminiferous tubules: There is progressive loss of germ cell elements so that the tubules may be lined by only spermatogonia and spermatids but foci of spermatogenesis are discernible in 10% of cases. Advanced cases show hyalinised tubules with a few Sertoli cells only, surrounded by prominent basement membrane. Interstitial stroma: There is usually increase in the interstitial fbrovascular stroma and conspicuous presence of Leydig cells, seen singly or in small clusters. Malignancy Cryptorchid testis is at 30-50 times increased risk of developing testicular malignancy. These causes can be divided into 3 groups: pre-testicular, testicular and post-testicular. The common routes of spread of infection are via the vas deferens, or via lymphatic and haematogenous routes.

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If laboratory evaluations are promise since it binds with cyanide to render it normal and the patient remains asymptomatic for at non-toxic without inducing methaemoglobinaemia. It is which hyperbaric oxygen therapy is mandatory especially evident in areas of postmortem lividity. The lining is usually badly Category 1 stands in contrast to the existing literature, damaged presenting a blackened, eroded surface. The most appropriate fuids and tissues to remove for chem ical analysis are blood, stomach contents, lung, liver, kidney, brain, heart, and spleen. There appears to be some evidence that cyanide can be generated in decomposing body tissues and fuids as a result of microbial action. As to whether this is signifcant enough to vitiate results of chemical analysis is unresolved, though it does not appear likely. But the reality is that except for certain excep tional situations, its employment in murder has been quite rare. Cyanide in fact has been more commonly involved in the commission of mass murder. Initially the Nazis used carbon monoxide, but later in order to expedite their gory task they began employing hydrogen cyanide (zyklon B). More recently, mass homicide (albeit on a much smaller scale) was accomplished with the help of 26. In November 1978, most of them (numbering around 900) died after drinking a cyanide solution prepared by Dr L Schat, a medical offcer of the cult on instructions issued by Jones 26. Cyanide has been (and continues to be) used legitimately to kill convicted criminals in some of the states of the 26. While cyanide has always been touted as a rapidly to the mortality in confagrations.

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Some suggestions to help you manage Here are some ideas to help you manage the changes and feelings that come with a diagnosis of kidney disease. Generally, it helps to talk about changes and feelings, and what they mean to you and your family. Most kidney services have people you can talk to regarding cultural or spiritual matters, or they can refer you to the appropriate service. Sometimes writing things down can help you cope with feelings, and eventually it makes talking about feelings easier. Living with Kidney Disease: A comprehensive guide for coping with chronic kidney disease 61 Your kidney team Your kidney team includes the following people. Renal social workers will work together with you and other team members to assess your needs and your social/family situation to fnd a way for you to best manage your disease. Surgeons create vascular access for haemodialysis, put in and remove peritoneal dialysis catheters and perform kidney transplants. Your kidney care team can recommend specialised help such as psychiatrists, psychologists or hospital chaplains. Local kidney patient support groups can be very helpful, especially if you want to talk to someone who is unrelated or not connected to your health care team about your concerns. Although treatment may be necessary, it is important not to let it control your life. Making the most of your visits When you visit any medical or health care professional, remember that they are there to help, advise and inform you of your condition and the treatment options available to assist you. Add to the list any symptoms, concerns or changes in your life that may have occurred recently or since your last visit. Whether you qualify for a beneft and how much you can get depends on your circumstances. Work and Income may be able to grant you assistance backdated to the date that you frst contacted them (so long as you complete your form within 20 working days of that date) or to the date that you submitted your application: whichever comes frst. Living with Kidney Disease: A comprehensive guide for coping with chronic kidney disease 67 Income and asset tests Most benefts are income tested: that is, they are determined according to the amount of your income. Depending on your income, you may be eligible for a full beneft, a part beneft or no beneft at all. It is important that you are aware of any extra entitlements you may be eligible for. You will need a medical certifcate from your doctor, or you may be able to provide existing reports or assessments or a report from your specialist.