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List 2: ceftibuten antibiotics for uti infection buy cheap myambutol 400 mg line, cefepime, cefixime, cefoperazone, cefotaxime, cefotetan, cefpodoxime, cefuroxime. Of concern if initiated after delivery Short-term intravenous or epidural use is acceptable. Infant must be closely monitored by a pediatrician if used during breastfeeding, as drug has potential effects on infant neurodevelopment, cardiac rhythm, and thyroid function. Progestin-only oral contraceptives are safer with respect to milk production; depot injections of medroxyprogesterone (Depo-Provera) are also acceptable. Note: 131Na-I treatment requires complete cessation of breastfeeding due to the concentration of this agent in the breast and in breast milk for weeks following completion of treatment. Index Note: Page numbers followed by an "f " denote figures; those followed by a "t" denote tables. See developmental dislocation of the hip Death neonatal bereavement, 225 decision making. See also hyperbilirubinemia joints, examination, 98 K kangaroo care, 175 Kayexalate, 281, 365 kernicterus, 317 ketoacidosis, 13 kidneys. See varicella-zoster virus W warfarin, newborn bleeding, 538 warmer, radiant, 49 well newborn care. First published in Great Britain in 1959 by Butterworths Medical Publications Second edition 1963 Third edition 1968 Fourth edition 1973 Fifth edition 1977 Sixth edition 1982 Seventh edition published in 1993 by Butterworth Heineman. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. Srinivasan, Surendar Tuli, Shunmugam Govender 3 Inflammatory rheumatic disorders Christopher Edwards, Louis Solomon 4 Crystal deposition disorders Louis Solomon 5 Osteoarthritis Louis Solomon 6 Osteonecrosis and related disorders Louis Solomon 7 Metabolic and endocrine disorders Louis Solomon 8 Genetic disorders, skeletal dysplasias and malformations Deborah Eastwood, Louis Solomon 9 Tumours Will Aston, Timothy Briggs, Louis Solomon 10 Neuromuscular disorders Deborah Eastwood, Thomas Staunton, Louis Solomon 11 Peripheral nerve injuries David Warwick, H. Pictures were unnecessary: if you had any sense (and were quick enough to get on the heavily oversubscribed Apley Course) you would be treated to an unforgettable display of clinical signs by one of the most gifted of teachers.

As with recurrent multifocal osteomyelitis infection control training cheap myambutol online visa, there is a curious association with cutaneous pustulosis. Vertebral changes include sclerosis of individual vertebral bodies, ossification of the anterior longitudinal ligament, anterior intervertebral bridging, end-plate erosions, disc space narrowing and vertebral collapse. Radioscintigraphy shows increased activity around the sternoclavicular joints and affected vertebrae. There is no effective treatment but in the long term symptoms tend to diminish or disappear; however, the patient may be left with ankylosis of the affected joints. It usually starts during the first few months of life with painful swelling over the tubular bones and/or the mandible. Infection may be suspected but, apart from the swelling, there are no local signs of inflammation. X-rays characteristically show periosteal new-bone formation resulting in thickening of the affected bone. After a few months the local features may resolve spontaneously, only to reappear somewhere else. The lesions gradually cleared up, leaving little or no trace of their former ominous appearance. In infants it is often difficult to tell whether the infection started in the metaphyseal bone and spread to the joint or vice versa. In practice it hardly matters and in advanced cases it should be assumed that the entire joint and the adjacent bone ends are involved. The causal organism is usually Staphylococcus aureus; however, in children between 1 and 4 years old, Haemophilus influenzae is an important pathogen unless they have been vaccinated against this organism. Occasionally other microbes, such as Streptococcus, Escherichia coli and Proteus, are encountered. In adults the effects are usually confined to the articular cartilage, but in late cases there may be extensive erosion due to synovial proliferation and ingrowth. If the infection goes untreated, it will spread to the underlying bone or burst out of the joint to form abscesses and sinuses. With healing there may be: (1) complete resolution and a return to normal; (2) partial loss of articular cartilage and fibrosis of the joint; (3) loss of articular cartilage and bony ankylosis; or (4) bone destruction and permanent deformity of the joint. The baby is irritable and refuses to feed; there is a rapid pulse and sometimes a fever. The joints should be carefully felt and moved to elicit the local signs of warmth, tenderness and resistance to movement. Special care should be taken not to miss a concomitant osteomyelitis in an adjacent bone end. All movements are restricted, and Pathology the usual trigger is a haematogenous infection which settles in the synovial membrane; there is an acute inflammatory reaction with a serous or seropurulent exudate and an increase in synovial fluid. As pus appears in the joint, articular cartilage is eroded and destroyed, partly by bacterial enzymes and partly by proteolytic enzymes released from synovial cells, inflammatory cells and pus. In infants the entire epiphysis, which is still largely cartilaginous, may be (a) (b) (c) (d) 2. Widening of the space between capsule and bone of more than 2 mm is indicative of an effusion, which may be echo-free (perhaps a transient synovitis) or positively echogenic (more likely septic arthritis). However, special investigations take time and it is much quicker (and usually more reliable) to aspirate the joint and examine the fluid. A white cell count and Gram stain should be carried out immediately: the normal synovial fluid leucocyte count is under 300 per mL; it may be over 10 000 per mL in non-infective inflammatory disorders, but counts of over 50 000 per mL are highly suggestive of sepsis. Samples of fluid are also sent for full microbiological examination and tests for antibiotic sensitivity. Differential diagnosis Acute osteomyelitis In young children, osteomyelitis may be indistinguishable from septic arthritis; often one must assume that both are present. Other types of infection Psoas abscess and local infection of the pelvis must be kept in mind. Trauma Traumatic synovitis or haemarthrosis may be associated with acute pain and swelling. Irritable joint At the onset the joint is painful and lacks some movement, but the child is not really ill and there are no signs of infection. Ultrasonography may help to distinguish septic arthritis from transient synovitis.

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Plates that are applied to the lateral surface of the femur: traditional angled blade-plates or 95 degree condylar screw-plates infection lung myambutol 800 mg without a prescription. For severely comminuted type C fractures, the newer plate designs with locking screws appear to offer an advantage over other implants; they provide adequate stability, even in the presence of osteoporotic bone, but (as with compression plates) unprotected weightbearing is best avoided until union is assured. They are also used to hold the femoral condyles together in type C fractures before intramedullary nails or lateral plates are used to hold the main supracondylar break (Figure 29. Careful assessment of the leg and peripheral pulses is essential, even if the x-ray shows only minimal displacement. A long period of exercise is needed in all cases, and even then full movement is rarely regained. For marked stiffness, arthroscopic division of adhesions in the joint or even a quadricepsplasty may be needed. Non-union Modern surgical techniques of internal fixation recognize the importance of minimizing damage to the soft tissues around the fracture; where possible, only those parts that are essential for fracture reduction are exposed. The knee joint may need to be opened for reduction of articular fragments but the metaphyseal area is left untouched in order to preserve its vitality. If non-union does occur, autogenous bone grafts and a revision of internal fix- (c) (d) 29. Unless great care is exercised during mobilization, the ultimate range of movement at the knee may be less than that at the fracture! Treatment the fracture can usually be perfectly reduced manually, but further x-ray checks will be needed over the next few weeks to ensure that reduction is maintained. Occasionally open reduction is needed; a flap of periosteum may be trapped in the fracture line. If there is a tendency to redisplacement, the fragments may be stabilized with percutaneous Kirschner wires or lag screws driven across the metaphyseal spike. The limb is immobilized in plaster and the patient is allowed partial weightbearing on crutches. Although not nearly as common as physeal fractures at the elbow or ankle, this injury is important because of its potential for causing abnormal growth and deformity of the knee. Although this type of fracture usually has a good prognosis, asymmetrical growth arrest is not uncommon and the child may end up with a valgus or varus deformity. Small areas of tethering across the growth plate can sometimes be successfully removed and normal growth restored. The influence of haemarthrosis on the development of femoral head necrosis following intracapsular femoral neck fractures. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical rele- vance of biochemical markers. Depending on the position of the knee, some will act as primary and others as secondary stabilizers. The cruciate ligaments provide both anteroposterior and rotary stability; they also help to resist excessive valgus and varus angulation. Both cruciate ligaments have a double bundle structure and some fibres of each bundle are taut in all positions of the knee (Petersen and Zantop, 2007). The anterior cruciate has anteromedial and posterolateral bundles, whereas the posterior cruciate has anterolateral and posteromedial bundles. Anterior displacement of the tibia (as in the anterior drawer test) is resisted by the anteromedial bundle of the anterior cruciate ligament Posterior oblique ligament including the superficial arm Superficial medial collateral ligament Semimembranosus including capsular, anterior and inferior arms Gastrocnemius (a) (a) Lateral gastrocnemius tendon Iliotibial tract Popliteus tendon Popliteofibular ligament Fibular collateral ligament (b) (b) 30. Injuries of the knee ligaments are common, particularly in sporting pursuits but also in road accidents, where they may be associated with fractures or dislocations. Mechanism of injury and pathological anatomy Most ligament injuries occur while the knee is bent, i. Cruciate ligament injuries occur in isolation or in combination with damage to other structures.

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The patient should be questioned and examined for evidence of gonococcal infection or drug abuse virus mega brutal buy myambutol 800mg without a prescription. Rheumatic fever Typically the pain flits from joint to joint, but at the onset one joint may be misleadingly inflamed. Juvenile rheumatoid arthritis this may start with pain and swelling of a single joint, but the onset is usually more gradual and systemic symptoms less severe than in septic arthritis. Sickle-cell disease the clinical picture may closely nase-resistant penicillins. If the initial examination shows Gram-negative organisms a third-generation cephalosporin is added. More appropriate drugs can be substituted after full microbiological investigation. This is the safest policy and is certainly advisable (1) in very young infants, (2) when the hip is involved and (3) if the aspirated pus is very thick. For the knee, arthroscopic debridement and copious irrigation may be equally effective. Older children with early septic arthritis (symptoms for less than 3 days) involving any joint except the hip can often be treated successfully by repeated closed aspiration of the joint; however, if there is no improvement within 48 hours, open drainage will be necessary. If articular cartilage has been preserved, gentle and gradually increasing active movements are encouraged. If articular cartilage has been destroyed the aim is to keep the joint immobile while ankylosis is awaited. Splintage in the optimum position is therefore continuously maintained, usually by plaster, until ankylosis is sound. Gout and pseudogout In adults, acute crystal-induced synovitis may closely resemble infection. On aspiration the joint fluid is often turbid, with a high white cell count; however, microscopic examination by polarized light will show the characteristic crystals. Treatment is then started without further delay and follows the same lines as for acute osteomyelitis. Once the blood and tissue samples have been obtained, there is no need to wait for detailed results before giving antibiotics. If the aspirate looks purulent, the joint should be drained without waiting for laboratory results (see below). The initial choice of antibiotics is based on judgement of the most likely pathogens. Neonates and infants up to the age of 6 months should be protected against staphylococcus and Gram-negative streptococci with one of the penicilli- Complications Infants under 6 months of age have the highest incidence of complications, most of which affect the hip. The most obvious risk factors are a delay in diagnosis and treatment (more than 4 days) and concomitant osteomyelitis of the proximal femur. Subluxation and dislocation of the hip, or instability of the knee should be prevented by appropriate posturing or splintage. Damage to the cartilaginous physis or the epiphysis in the growing child is the most serious complication. Sequelae include retarded growth, partial or complete destruction of the epiphysis, deformity of the joint, epiphyseal osteonecrosis, acetabular dysplasia and pseudarthrosis of the hip. Articular cartilage erosion (chondrolysis) is seen in 45 2 older patients and this may result in restricted movement or complete ankylosis of the joint. Even in affluent communities the incidence of sexually transmitted diseases has increased (probably related to the increased use of non-barrier contraception) and with it the risk of gonococcal and syphilitic bone and joint diseases and their sequelae. The usual organisms are Staphylococcus aureus and Streptococcus; however, opportunistic infection by unusual organisms is not uncommon. The patient may present with an acutely painful, inflamed joint and marked systemic features of bacteraemia or septicaemia.

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X-rays Radiographic examination may show little abnormality virus treatment buy myambutol 400 mg cheap, apart from local osteoporosis. In the elderly the injury is usually above the patella; in middle life the patella fractures; in young adults the patellar ligament can rupture. Tendon rupture sometimes occurs with minimal strain; this is seen in patients with connective tissue disorders. Treatment Both the haematologist and the orthopaedic surgeon should participate in treatment. Flexion deformity must be prevented by gentle physiotherapy and intermittent splintage. However, although replacement arthroplasty is feasible, this should be done only after the most searching discussion with the patient, where all the risks are considered, and only if a full haematological service is available. Avulsion of the quadriceps tendon from the upper pole of the patella is seen in the same group of people. The patient stumbles on a stair, catches his or her foot while walking or running, or may only be kicking a muddy football. It is generally ascribed to ossification of a haematoma following a tear of the medial ligament, though a history of injury is not always forthcoming. This condition was described independently by Sinding-Larsen in 1921 and Johansson in 1922. Sometimes, if the condition does not settle, calcification appears in the ligament (Medlar and Lyne, 1978). If rest fails to provide relief, the abnormal area is removed and the paratenon stripped (King et al. Although often called osteochondritis or apophysitis, it is nothing more than a traction injury of the apophysis into which part of the patellar tendon is inserted (the remainder is inserted on each side of the apophysis and prevents complete separation). Sometimes active extension of the knee against resistance is painful and x-rays may reveal fragmentation of the apophysis. Spontaneous recovery is usual but takes time, and it is wise to restrict such activities as cycling, jumping and soccer. Occasionally, symptoms persist and, if patience or wearing a back-splint during the day are unavailing, a separate ossicle in the tendon is usually responsible; its removal is then worthwhile. Conditions to be considered can be divided into four groups: swelling of the entire joint; swellings in front of the joint; swellings behind the joint; and bony swellings. X-rays are essential to see if there is a fracture; if there is not, then suspect a tear of the anterior cruciate ligament. If a ligament injury is suspected, examination under anaesthesia is helpful and may indicate the need for operation; otherwise a crepe bandage is applied and the leg cradled in a back-splint. The patient may get up when comfortable, retaining the back-splint until muscle control returns. If the appropriate clotting factor is available, the joint should be aspirated and treated as for a traumatic haemarthrosis. If the factor is not available, aspiration is best avoided; the knee is splinted in slight flexion until the swelling subsides. The organism is usually Staphylococcus aureus, but in adults gonococcal infection is almost as common. Aspiration reveals pus in the joint; fluid should be sent for bacteriological investigation, including anaerobic culture. The knee may need to be splinted for several days but movement should be encouraged and quadriceps exercise is essential.

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About the Security Industries Authority Staff

The Security Industies Authority is headed by a Registrar as the CEO and has thirteen (13) other staff members from all four (4) regions of the country working under him. These includes the Manager Finance and Administration, Manager Licensing and Compliance and four (4) Regional inspectors(MOMASE, Islands, Highland and Southern).

The Inspectors job are very challenging because they are at the front line of enforcement to ensure that private security companies are compliant with the provisions of the Security Protection Act to operate a security company. Most of them are former officers of the Royal PNG Constabulary. Apart from them we also have a efficient staff made up of the Executive Secretary, Accounts Officer, HR Officer , I.T Officer & an Office Janitor in Head Office Port Moresby while Admin Assistance/ Driver and an Office Admin/ Reception in Lae Momase & Highlands Region branch office.

Staff Profiles


Mr. Paul Kingston Isari

Registrar & CEO of PNG Security Industries Authority


Mr. Philip Gene, BAC, CPA PNG

Manager Finance & Administration


Mr. Spencer Gelo

Manager Licencing & Compliance

POM Office Staff

Front left – right Ms Margaret Biskum- Security Inspector New Guinea Islands, Ms Alicia Nana – Executive Secretary & Mrs Mackey Kembi Office Janitor

Back left – right Mr. Rinson Ngale – Security Inspector NCD/Southern Region, Mr. Emmanuel Tumbe HR Officer, Mr. Elijah Fave – Accounts Officer, Mr. Andrew Kaiap – I.T Officer


Lae Office Staff

Front left – right Ms Nelison Roberts – Office Secretary / Reception , Mr. Elvis Otare – Office Admin Assistance / Driver & Acting Momase Region Inspector

Back left – right Vacant – Office Manager & Security Inspector Momase Region, Mr. Pius Moi – Acting Office Manager Security Inspector Highlands Region

Security Industries Authority organizational chart


Vacancies for Council Representatives from the Security
Industry to sit in the Council

The Security Industries Authority currently does not have any vacant Council Representative position. There in total six (6) nominated representative from Security Industries in the council.(see SIA Council)

Qualified candidates will be made known here if there is a vacant in Council Representative positions.

Security Industries Authority Position Vacancies

SIA Currently has no vacancy positions available. Public will be notified for any positions available in the future.

Criteria for appointment to the Security Industries Council

  1. The candidates must have a sound knowledge in the operations of private security companies and are quite versed with the Security Protection Act 2004.
  2. The candidates shall not be currently employed in any licensed security companies that are currently registered with the Security Industries Authority or were not previously employed by any licensed security companies.
  3. The candidates shall not be a current owner or a shareholder of a licensed security company currently registered with the Security Industries Authority and the IPA (Investment promotion Authority).
  4. The candidates shall not be a previous owner or a shareholder of a licensed security company registered with the Security Industries Authority or with the IPA. (Investment promotion Authority).
  5. Interested persons may submit their application with a CV with three (3) references named and attached with their latest passport size photos.
  6. Both male and females are encouraged to participate.
  7. Only registered security companies and permitted security guards will participate in the nominations.
  8. All candidates shall be subjected to a fit and proper persons test before they are formally appointed for 3 years term by the Minister for Police & Internal Security.

For enquiries on this matter

Visit us at the Top floor of the Former Fraud Squad blue building, Gorobe Street, Badili, 2 Mile, Port Moresby NCD or Lae at Post Office Building, second street, top floor, suite # 14, Lae Morobe Province or write to the Chairman Security Industries Council PO BOX 80 Port Moresby National capital District. You can also contact Manager Licensing & Compliance – Mr. Spencer Gelo on telephone 3239851 / 3257930, or email executivesecretary@sia.gov.pg

Invitation to the Stake Holders and the Industry to make a submission on the amendments to current security Protection Act

The Registrar now invites all the registered security companies, service receivers and interested stake holders for their written submission to amend the current Security Protection Act to cover many grey areas of the law.

The submissions should clearly state what provisions of the current Security Protection Act 2004 and the Security Protection regulation 2012 are to be amended to enhance the growth of the industry. This is necessary in light of numerous complaints from the security companies and interested stake holders of the short falls in the current Act which is said to be hindering the growth of the industry.

All submissions must be dropped at The Authority Head Office: Former Fraud Squad Office, Top Floor, Gorobe Street, 2 Mile Drive, Badili,Boroko NCD in Port Moresby. They can also be posted or emailed using the address on the last page. Copies of the current Security Protection Act 2004 can be obtained at the Security Industries Authority office for K35 to use as a guide to prepare the submissions.

Appointment to the Board of Complaints

The Security Industries Authority in compliance with section 57 of the Security Protection Act 2004 has already advertised in the media in early February 2013 seeking for two (2) interested persons to sit on the Board of Complaints.

The purposes of the Board of Complaints is to hear allegations made against licensed security companies by the general public and to award appropriate disciplinary penalties to protect the integrity of the security industry. Several applications have already been received and the short listed candidates will be advised in writing by the chairman shortly before a final selection is made for their three (3) yeas appointments by the Minister for Police and Internal Security.