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Cytologic examination of specimens obtained from the bases of unroofed vesicles may disclose eosinophilic inclusions (Guarnieri bodies) which are sites of viral replication in the cytoplasm erectile dysfunction low testosterone treatment order suhagra american express. Poxviruses may also be identified by electron microscopy of specimens obtained from skin lesions; however, these methods will not differentiate poxviruses. Clinical specimens (serum, respiratory secretions, specimens obtained from skin lesions or crusts) may be sent to the laboratory for culture. Poxviruses may be identified by differential growth characteristics in tissue culture. Case-fatality rate for smallpox (variola major) was historically 20 to 40 percent and higher during pregnancy or the neonatal period. Case fatality for the flat-type variant was approximately 95 percent in the unimmunized and 66 percent in previously immunized patients. Strict (standard, contact, and airborne) isolation and quarantine of all patients must be maintained until scabs have separated. Smallpox can also be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Rarely, smallpox has been spread by virus carried in the air in enclosed settings. Sterilize (autoclave or boil) all bedclothes and other fabrics that are exposed to the patient. Spray or mop all floors, walls, and other hard surfaces in the patient isolation area with a disinfectant solution (phenolic and quaternary ammonium compounds, formalin, or a 5 percent chlorine solution). Guidance on patient contacts are discussed below: the reappearance of a single case of smallpox would be a global emergency. Quarantine all direct contacts with any case and maintain daily surveillance for 17 days after last known contact with a case. Vaccinate all contacts, including medical workers, if they have not been immunized or received a booster within 3 years. Conduct an epidemiological investigation to identify all potentially exposed personnel. Quarantine identified personnel for the remainder of the incubation period; usually 7 to 12 days following the appearance of index cases. Enzootic strains are frequently transmitted to humans living in endemic disease areas via mosquito bites. In contrast to enzootic strains, epizootic strains are highly virulent for equidae (horses, mules, donkeys). Horses serve as amplifying hosts of epizootic (but not enzootic) strains, providing a source of virus for mosquitoes, which transmit virus to humans. Alphaviruses are a large group of viruses that are spread by certain invertebrate animals, mainly bloodsucking insects. Birds are often the source of infection for mosquitoes, which can sometimes spread the infection to horses, other animals, and people. Aerosolized exposure is not the normal route of exposure, and it is unknown if any cases of aerosolized transmission have occurred. The usual presentation is an undifferentiated febrile illness with fever, malaise, and headache. Other symptoms that may appear include myalgia (72 percent), vomiting (50 percent), drowsiness (40 percent), chills (20 percent), sore throat (20 percent), and diarrhea (20 percent). Less than 1 percent of adults will develop severe encephalitis featuring meningismus, ataxia, seizures, and coma; paralysis and neurologic sequelae may result in survivors. Susceptibility in humans is high (90 to 100 percent) and nearly 100 percent of those infected develop overt illnesses. There are no postexposure prophylaxes in Biological Warfare Clinical Presentation 4-35. A single high titer IgM value 5 to 7 days after the onset of illness is supportive; a four-fold rise in antibody titer in paired acute and convalescent sera is diagnostic. Viral cultures may confirm the diagnosis if serum or pharynx samples are sent early during the illness (a low titer viremia is present during the first 24 to 72 hours of illness and pharyngeal cultures may contain virus up to 8 days); however, cultures will be negative later in the clinical course and in those who have progressed to encephalitis. Nonspecific laboratory findings include lymphopenia and occasionally, neutropenia and mild thrombocytopenia. Administer anticonvulsive therapy for patients with seizures and other supportive care measures as indicated. They are unified by their potential to present as a severe febrile illness accompanied by shock and hemorrhagic diathesis.

It appears that cyclic loading is the most effective method of recruiting extra tissue online erectile dysfunction drugs reviews buy suhagra on line. Skin creep alone does not account for all the extra skin during serial expansion, and factors such as recruitment, tissue compression/thinning, and new growth also play a role. The author later reported intraoperative expansion in closure of small skin defects on an emergency basis. Sasaki states that these shortcomings of slow expansion are eliminated by the intraoperative expansion technique. Siegert et al45 evaluated intermittent intraoperative short-term tissue expansion in dogs and in 30 patients with severe microtia. The authors mention mechanisms that lead to an increase in skin length (Fig 1)-elasticity, interstitial displacement of fluids, creep, and genuine growth- yet fail to credit any of these specifically for their findings. Instead, they attribute the mechanism of expansion to another, undefined form of subcutaneous mobilization. Shapiro48 combines acute cycled expansions with rectangular skin flaps and notes a decrease in wound closing tension compared with simple flap undermining. Nevertheless, the author states that "undermining must still be considered the most important element in reducing wound closing tension. To date expanders have been used to good effect in the head and neck, the extremities, the trunk, and for breast reconstruction. Expanders are generally contraindicated in areas of poorly vascularized tissue, where there is localized infection, or if there is a higher-thanaverage risk of recurrent cancer. Fisher and Hammond53 review the literature of expanders combined with flaps for breast reconstruction. Most reports of reconstruction by tissue expansion imply movement of tissue as advancement flaps. The expander can be of any shape but should be twice as wide as the defect to be covered. Wilmhurst and Sharpe55 insert tissue expanders immediately after resection of malignant skin lesions to complete the reconstruction in two operations. Austad56 advocates against tissue expansion in acute injuries because of the risk of contamination and possible inability to obtain rational informed consent on an emergency basis. He reminds us that tissue expansion results in a distortion of body image that some patients are unable to tolerate. The authors compared the efficacy of continuous versus intraoperative tissue expansion in a pig model, and find three times more tissue gain with the former technique. Wickman and colleagues52 measured mechanical properties of the skin during rapid and slow tissue expansion for breast reconstruction. Distensibility lessened during expansion, increased after the expander was replaced by a permanent implant, and decreased thereafter. Elasticity did not change significantly and neither did hysteresis (a measure of the skin turgor and plasticity). In summary, there were minimal differences in skin properties between rapidly and slowly expanded patients. Austad56 notes a remarkable absence of disasters in a survey of more than 50,000 tissue expansion procedures, and points out that the overall incidence of complications associated with tissue expansion has decreased as surgeons have become more knowledgeable and experienced in the routine use of expanders. Austad recounts four cases of partial flap necrosis after the expander had been removed and the flap advanced over the defect, and attributes the cyanosis to epinephrine in the local anesthetic solution known to be detrimental to the survival of delayed-hence expanded-flaps. Minor complications were noted in 17% and included pain on expansion, seroma, and widening of scars. Argenta and associates18 also noted a 24% complication rate early in their series, but this subsequently fell to 7%. Infection is usually reported in 1% of cases, and only in patients with predisposing factors. The most frequent cause of exposure is an insufficient pocket at the initial procedure that forces the prosthesis against the suture line. Sharp edges or irregular folds in the prosthesis should also be smoothed out or risk thinning of the shell from friction and perhaps implant exposure. Argenta recommends waiting for 2 weeks after implantation of the expander before beginning inflation. Zoltie and associates59 review their experience with non-scalp, non-breast tissue expansion in 56 patients, and report an overall failure of 12%.

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Absence of a medicine from the list does not imply safety Medicine Comment Abacavir Acetazolamide Acetylsalicylic acid Toxicity in animal studies; see section 6 erectile dysfunction treatment lloyds buy cheap suhagra 50 mg on-line. Toxicity to the infant can occur if the drug enters the breast milk in pharmacologically significant quantities. The concentration in milk of some drugs (for example, iodides) may exceed the concentration in the maternal plasma so that therapeutic doses in the mother may cause toxicity to the infant. For many drugs insufficient evidence is available to provide definitive guidance and it is advisable to administer only drugs essential to a mother during breastfeeding. Because of the inadequacy of information on drugs in breast milk, the following table should be used only as a guide; absence from the table does not imply safety. Infants should be exclusively breastfed for the first 6 months of life; thereafter they should receive appropriate complementary food and continue to be breastfed up to 2 years of age or beyond. The sensitivity to some drugs is increased even if the renal elimination is unimpaired. The level of renal function below which the dose of a drug must be reduced depends on how toxic it is and whether it is eliminated entirely by renal excretion or is partly metabolized to inactive metabolites. In general, all patients with renal impairment are given a loading dose which is the same as the usual dose for a patient with normal renal function. The maintenance dose of a drug can be reduced either by reducing the individual dose leaving the normal interval between doses unchanged or by increasing the interval between doses without changing the dose. The following table lists drugs, in alphabetical order, for which specific information on use in renal impairment (including recommended doses) is available. Many drugs should be used with caution in renal impairment but no specific advice on dose adjustment is available; it is therefore important to also refer to the individual drug entries. It is advisable to determine renal function not only before but also during the period of treatment and adjust the maintenance dose as necessary. When prescribing for the elderly, assume at least a mild degree of renal impairment. Altered volume of distribution of drugs due to increased extracellular fluid (ascites, oedema) and decreased muscle mass. Decreased protein binding and increased toxicity of drugs highly bound to proteins (for example phenytoin) due to impaired albumin production. Decreased bioavailability due to malabsorption of fats in cholestatic liver disease. However, most hepatotoxic reactions to drugs are rare but tend to be unpredictable. Information to help prescribing in hepatic impairment is included in the following table. The increased potential (in adolescents compared with adults) for weight gain and dyslipidemia may lead clinicians to consider prescribing other drugs first in adolescents. Oral: Start at 5-10 mg once daily; Target: 10 mg/day within several days Oral: Start at 2. Patients taking olanzapine should be monitored for symptoms of hyperglycemia and undergo fasting blood glucose testing at the beginning of, and periodically during, treatment. Appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of, and periodically during, treatment. Use caution in patients with cardiovascular disease, cerebrovascular disease, and those conditions that could affect hemodynamic responses. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Efficacy was established in three clinical trials in adult patients with schizophrenia: two 6-week trials and one maintenance trial.

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Scabs form in 8 to 14 days and slough off in 14 to 28 days after the onset of the rash can you get erectile dysfunction pills over the counter purchase generic suhagra online. It is important to distinguish the differences in rash distribution between smallpox, chickenpox, and monkeypox. Smallpox begins on oral mucosa, spreads to face, then expands in centrifugal pattern (meaning that the rash is most dense on face and distal extremities then spreads to the trunk). Chickenpox begins on trunk and expands in centripetal pattern (meaning that the rash is most dense on the trunk then spreads to the distal extremities). Monkeypox often begins on face and spreads in centrifugal pattern (although cases have been reported with centripetal pattern of spread). Variants include flat-type smallpox, featuring severe systemic toxicity and large flat maculopapular lesions with a soft, velvety, nonindurated texture. The most severe clinical presentation of smallpox is the hemorrhagic variant, featuring severe systemic toxicity, and diffuse ecchymosis and purpura. This variant is associated with a high-titer viremia and absent or negligible antibody responses and patients usually died before the characteristic papules or vesicles appeared. A relatively mild form of smallpox, featuring limited systemic toxicity and a milder exanthem was seen in parts of southern Africa, Europe, and Latin America. Complications of smallpox include encephalitis in one per 500 cases, with high rates of mortality and neurologic sequelae among survivors. Keratitis with corneal ulceration leading to blindness occurred in one percent of cases. Pulmonary edema could complicate the course of hemorrhagic and flat-type variants. Differential diagnosis of a vesicular or pustular exanthem may include consideration of other infections (varicella, enteroviruses, rickettsialpox, septicemic melioidosis) or autoimmune diseases (dermatitis herpetiformis, bullous erythema multiforme, and so forth). Taxonomy of hemorrhagic fever viruses Virus Arenaviridae Family New World Complex Junin Machupo Guanarito Sabia Old World Complex Lassa Bunyaviridae Family Phlebovirus genus Rift Valley Rift Valley fever Africa Mosquito Mosquito, aerosol or fomites from slaughtering infected animals Mosquito, aerosol or fomites from slaughtering infected animals Aerosol, fomites Aerosol, fomites Lassa fever W. However, with some viruses, after the accidental transmission from the host, humans can transmit the virus to one another. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents. The viruses associated with arthropod vectors are spread most often when the vector mosquito or tick bites a human, or when a human crushes a tick. Some viruses that cause hemorrhagic fever can spread from one person to another, once an initial person has become infected. This type of secondary transmission of the virus can occur directly, through close contact with infected people or their body fluids. It can also occur indirectly, through contact with objects contaminated with infected body fluids. For example, contaminated syringes and needles have played an important role in spreading infection in outbreaks of Ebolavirus hemorrhagic fever and Lassa fever. Some hemorrhagic fever viruses (for example, Ebola virus) may persist in tissues and body fluids (for example, semen) of patients who have recovered from clinical disease but may remain infectious for several months after the disappearance of clinical signs. Viral hemorrhagic fever is a clinical syndrome featuring fever, myalgia, malaise, and hemorrhage, and in some cases, hypotension, shock, and death. Viral pathogenesis is complex, incompletely understood, and varies among specific viruses. Some infections result in immune complex deposition which activates complement and other inflammatory cascades. This process damages vascular endothelium, results in capillary leak, and deregulates vascular smooth muscle tone. For example, yellow fever can cause massive hepatic necrosis resulting in a deficiency of vitamin K-dependent clotting factors. For preexposure prophylaxis, ensure all Service members have received their yellow fever vaccinations. Argentine hemorrhagic fever live attenuated vaccine has been safely used and has proven effective with greater than 95 percent efficacy. Prophylactic antiviral therapy is not recommended for persons exposed to any hemorrhagic fever viruses (including Lassa virus) in the absence of clinical illness.

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.