Differentiation of upper from lower urinary tract infection in young children is not possible on clinical grounds 20mg forzest sale erectile dysfunction treatment in ayurveda. Features of urinary tract infections in children Signs and symptoms are related to the age of the child and are often non-specific buy forzest 20 mg lowest price occasional erectile dysfunction causes. Neonates may present with: » fever » hypothermia » poor feeding » sepsis » vomiting » prolonged jaundice » failure to thrive » renal failure Infants and children may present with: » failure to thrive » frequency » persisting fever » dysuria » abdominal pain » enuresis or urgency » diarrhoea In any child with fever of unknown origin, the urine must be examined, to assess whether a urinary tract infection is present. If a bag specimen reveals the following, a urine specimen must be collected aseptically for culture and sensitivity: » positive leukocytes or nitrites on dipstix in freshly passed urine » motile bacilli and increased leukocytes or leukocyte casts on urine microscopy Urine dipstix should be performed on a fresh urine specimen. For pregnant women and adolescents: Amoxicillin/clavulanic acid 875/125 mg, oral, 1 tablet 12 hourly for 7 days. Acute pyelonephritis Outpatient therapy is only indicated for women of reproductive age, who do not have any of the manifestations requiring referral (see referral criteria below). Ill patients awaiting transfer » Ensure adequate hydration with intravenous fluids. Non-urgent » All children for urinary tract investigations after completion of treatment. Clinical features include: » perineal, sacral or suprapubic pain » dysuria and frequency » varying degrees of obstructive symptoms which may lead to urinary retention » sometimes fever » acutely tender prostate on rectal examination The condition may be chronic, bacterial or non-bacterial, the latter usually being assessed when there is failure to respond to antibiotics. Glomerular disease is suggested if proteinuria, red blood cell casts and/or dysmorphic red blood cells are present on microscopy. Note: The presence of blood on the urine test strips does not indicate infection and should be investigated as above. If haematuria does not resolve rapidly after treatment referral for formal investigation will be required, i. May be associated with both obstructive (weak, intermittent stream and urinary hesitancy) and irritative (frequency, nocturia and urgency) voiding symptoms. Urinary retention with a distended bladder may be present in the absence of severe symptoms, therefore it is important to palpate for an enlarged bladder during examination. For patients presenting with urinary retention, insert a urethral catheter as a temporary measure while patient is transferred to hospital. As the axial skeleton is the most common site of metastases, patients may present with back pain or pathological spinal fractures. It is important, however, to differentiate between nocturnal enuresis and daytime wetting with associated bladder dysfunction. Secondary causes of enuresis include: » diabetes mellitus » urinary tract infection » physical or emotional trauma Note: » Clinical evaluation should attempt to exclude the above conditions. Clinical features of obstructing urinary stones may include: » sudden onset of acute colic, localized to the flank, causing the patient to move constantly, » nausea and vomiting, » referred pain to the scrotum or labium on the same side as the stone moves down the ureter. Antimicrobial resistance patterns in outpatient urinary tract infections--the constant need to revise prescribing habits. Antimicrobial susceptibility patterns of Escherichia coli strains isolated from urine samples in South Africa from 2007-2011. Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa. A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Intensive Care Unit, Royal Children’s Hospital, Parkville, Victoria 3052, Australia. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. Treatment targets Additional Parameter Optimal Acceptable action suggested Finger-prick blood glucose values: fasting (mmol/L) 4–7 <8 >8 2-hour post-prandial (mmol/L) 5–8 8–10 >10 Glycosylated haemoglobin (HbA1c) (%) <7 7–8 >8 Blood pressure Systolic <140 mmHg Diastolic <90 mmHg i LoE:I The increased risk of hypoglycaemia must always be weighed against the potential benefit of reducing microvascular and macrovascular complications. Insulin regimens Basal bolus regimen All type 1 diabetics should preferentially be managed with the “basal bolus regimen” i. This consists of pre-meal, short-acting insulin and bedtime intermediate-acting insulin not later than 22h00. The total dose is divided into: o 40–50% basal insulin o The rest as bolus insulin, split equally before each meal. It is a practical option for patients who cannot monitor blood glucose frequently. Drawing up insulin from vials » Clean the top of the insulin bottle with an antiseptic swab. In thin people it may be necessary to pinch the skin between thumb and forefinger of one hand. Prefilled pens and cartridges In visually impaired patients and arthritic patients, prefilled pens and cartridges may be used. However, an increasing number of adolescents are being diagnosed with type 2 diabetes mellitus. Criteria for screening for diabetes in children th » Body mass index > 85 percentile for age and sex. It is difficult to distinguish type 2 from type 1 diabetes mellitus, as many type 1 diabetics may be overweight, or have a family history of type 2 diabetes mellitus, given the increasing prevalence of both obesity and type 2 diabetes mellitus. The diagnosis of type 2 diabetes mellitus in adolescents should be made in consultation with a specialist. Most adults with type 2 diabetes mellitus are overweight with a high waist to hip ratio. In adults the condition might be diagnosed only when presenting with complications, e. Suspect type 1 diabetes mellitus among younger patients with excessive weight loss and/or ketoacidosis. Treatment targets Additional Parameter Optimal Acceptable action suggested Finger prick blood glucose values: fasting (mmol/L) 4–7 <8 > 8 2-hour post-prandial (mmol/L) 5–8 8–10 > 10 Glycosylated haemoglobin (HbA1c) (%) < 7 7–8 > 8 Blood pressure Systolic < 140 mmHg Diastolic < 90 mmHg » In the elderly, the increased risk of hypoglycaemia must be weighed against the potential benefit of reducing microvascular and macrovascular complications. For treatment of hypertension and dyslipidaemia after risk-assessment, see Section 4. Diet » Consider the following for a person-centred approach to diet therapy: Weight. These foods are digested slowly resulting in a slow and steady rise in blood glucose concentrations. Fruit and vegetables » Eat a variety of fruit and vegetables – 4 to 5 portions on a daily basis. Insulin type Starting dose Increment Add on 10 units in the evening before If 10 units not effective: therapy: bedtime, but not after 22h00. Risk factors include age < 6 years of age, low HbA1c and longer duration of diabetes. Hypoglycaemia in diabetic patients can be graded according to the table below: Mild/moderate hypoglycaemia Severe hypoglycaemia » Capable of self-treatment*. Autonomic symptoms/signs Neurological symptoms/signs » Tremors » Headache » Palpitations » Mood changes » Sweating » Low attentiveness » Hunger » Slurred speech » Fatigue » Dizziness » Pallor » Unsteady gait » Depressed level of consciousness/ convulsions *Note: » Children, particularly < 6 years of age, generally are not capable of self- management and are reliant on supervision from an adult. If a diabetic patient presents with an altered level of consciousness and a glucometer is not available, treat as hypoglycaemia. Conscious patient, not able to feed without danger of aspiration Administer via nasogastric tube: Dextrose 10%, 5 mL/kg o Add 1 part 50% dextrose water to 4 parts water to make a 10% solution.
In patients with diabetes and hypertension order forzest 20mg on-line erectile dysfunction no xplode, any of the frst-line antihypertensive Strong I drugs that effectively lower blood pressure are recommended discount forzest 20mg with visa erectile dysfunction doctor michigan. In patients with diabetes and hypertension, a blood pressure target of <140/90 Strong I mmHg is recommended. In patients with diabetes where treatment is being targeted to <120 mmHg systolic, close follow-up of patients is recommended to identify treatment related Strong – adverse effects including hypotension, syncope, electrolyte abnormalities and acute kidney injury. Recommendations for patients with hypertension and prior myocardial infarction Patients with hypertension and previous myocardial infarction Grade of Level of recommendation evidence a. Recommendations for patients with hypertension and chronic heart failure Grade of Level of Patients with hypertension and chronic heart failure recommendation evidence a. Strong I *Carvedilol; bisoprolol (beta-1 selective antagonist); metoprolol extended release (beta-1 selective antagonist); nebivolol Recommendations for patients with hypertension and peripheral arterial disease Grade of Level of Patients with hypertension and peripheral arterial disease recommendation evidence a. In patients with hypertension and peripheral arterial disease, reducing blood pressure to a target of <140/90 mmHg should be considered and treatment guided Strong – by effective management of other symptoms and contraindications. National Heart Foundation of Australia Guideline for the diagnosis and management of hypertension in adults 2016 3 Recommendations for treatment of hypertension in older persons Older persons with hypertension Grade of Level of recommendation evidence a. Any of the frst-line antihypertensive drugs can be used in older patients with hypertension. When starting treatment in older patients, drugs should be commenced at the Strong – lowest dose and titrated slowly as adverse effects increase with age. Clinical judgement should be used to assess the beneft of treatment against the Strong – risk of adverse effects in all older patients with lower grades of hypertension. Recommendations for patients with hypertension and suspected blood pressure variability Patients with hypertension and suspected blood pressure variability Grade of Level of recommendation evidence a. For high-risk patients with suspected high variability in systolic blood pressure between visits, a focus on lifestyle advice and consistent adherence to Strong I medications is recommended. Drug therapy should not be selected based on reducing blood pressure variability per se but in accordance with current recommendations, which Strong already prioritise the most effective medications. Recommendations for the use of renal denervation in treatment resistant hypertension Patients with treatment resistant hypertension Grade of Level of recommendation evidence a. Recommendation for patients with hypertension requiring antiplatelet therapy Antiplatelet therapy for patients with hypertension Grade of Level of recommendation evidence a. The National Heart Foundation of This edition of the guideline offers advice on new areas including out-of-clinic blood pressure measurement using Australia’s Guideline for the diagnosis ambulatory or home procedures, white-coat hypertension and management of hypertension and blood pressure variability. There has been considerable development of treatment strategies and in adults – 2016 provides updated targets according to selected co-morbidities, which often recommendations on the management of occur in combination. In contrast to the previous edition, Guide to management An additional key difference is the new evidence for a of hypertension 2008 (updated 2010), this guideline target blood pressure of <120 mmHg in particular patient provides a description of recent evidence rated groups. Hypertension is a major risk factor and antecedent of However, this edition includes both a primary and cardiovascular and end organ damage (myocardial secondary prevention focus on the contemporary infarction, chronic kidney disease, ischaemic and management of hypertension in the context of an ageing haemorrhagic stroke, heart failure and premature death). It should not be treated alone, but include assessment For primary prevention, the emphasis in this guideline is of all cardiovascular risk factors in a holistic approach, on targeting absolute risk, preferably assessed using the incorporating patient-centred lifestyle modifcation. However this approach is limited to particular age groups (>35 in Aboriginal and Torres Strait Islander peoples, >45 in non-Indigenous Australians) and does not always account for important comorbidities or target organ damage in hypertension that are known to increase risk. It has therefore been necessary to make recommendations based on recent evidence outside the patient groups covered by the absolute cardiovascular risk guidelines. Furthermore, a number of important recent trials have addressed blood pressure targets as a single risk factor in people with moderate or high risk assessed by other methods. National Heart Foundation of Australia Guideline for the diagnosis and management of hypertension in adults 2016 5 6 Guideline for the diagnosis and management of hypertension in adults 2016 National Heart Foundation of Australia 1 Introduction Statement of purpose: This guideline This guideline adheres to the fundamental principles applied to previous guidelines including: aims to arm health professionals working • to base recommendations on high-quality studies across the Australian healthcare system, identifed from an extensive literature review in particular those working within • to prioritise data from large systematic reviews and primary care and community services, randomised controlled trials, adding observational and with the latest evidence for controlling other studies where appropriate. Where hypertension with and without co- there is no direct evidence for a recommendation that morbidities. Only English- This guideline builds on the previous Guide to management language titles were reviewed and this edition will only be of hypertension (updated 2010). One common observational study is the possible effect of a treatment, where the assignment of subjects into a treated or control groups is not controlled by the investigator. Australian guidelines to reduce health risks from This guideline details evidence primarily on essential drinking alcohol. Current evidence-based guidelines in other areas are • National Health and Medical Research Council. Areas not included are aligned to Smoking cessation guidelines for Australian general associated guidelines and include: practice. Clinical practice guidelines for the management of overweight • specialist management of secondary hypertension and obesity in adults, adolescents and children in • diagnosis and treatment of hypotension Australia. Reducing risk guidelines are comprehensive, they should be considered of heart disease: An expert guide to clinical practice for in the context of other affliated clinical guidelines. Management of patients with peripheral artery disease (lower extremity, renal, • National Heart Foundation of Australia. Guidelines for the management of arterial Guidelines for preventive activities in general practice. National evidence based guidelines for the management of chronic kidney disease in type 2 diabetes. Hypertension is an independent risk factor for identifed up to December 2015 was also reviewed and myocardial infarction, chronic kidney disease, ischaemic included. Publications in languages other than English and haemorrhagic stroke, heart failure and premature were not included. Committee members produced evidence summaries untreated or uncontrolled hypertension was lowest in that were approved by the committee and used to draft the Northern Territory (19. The prevalence of hypertension has also been the literature and reach consensus recommendations. While approximately shortly after the public consultation process, had the one-third of the Australian population have been told by potential to alter recommendations. Before publication, the guideline was reviewed by 6 untreated or uncontrolled hypertension. This guideline was developed Torres Strait Islander adults were 50% more likely to die with signifcant contributions of experts, who acted in an from circulatory diseases compared with non-Indigenous honorary capacity, and resourced by the National Heart 7 Australians. Findings suggest that controlled blood pressure is associated with lower risk of stroke, coronary heart disease, chronic kidney disease, heart failure and death. Hypertension is a signifcant determinant of an individual’s overall cardiovascular risk. Lowering blood pressure by only 1–2 mmHg within a population is known to markedly reduce cardiovascular morbidity and mortality. Treatment with oral drugs and follow-up within 24–72 pressure has a continuous relationship hours are recommended. In practice, however, cut-off values hypertensive encephalopathy, papilloedema, cerebral are used to aid diagnosis and management decisions. Hospitalisation (usually blood pressure categories and grades of hypertension are in an intensive care unit), close blood pressure monitoring described in Table 2. Confrmed follow-up is essential to The presence of these features indicates the need for ensure effective blood pressure control.
Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort buy forzest 20 mg line erectile dysfunction doctors in toms river nj. Intravitreal triamcinolone acetonide for the treatment of immune recovery uveitis macular edema purchase discount forzest on line erectile dysfunction caused by hemorrhoids. Incidence of foscarnet resistance and cidofovir resistance in patients treated for cytomegalovirus retinitis. Mutations conferring ganciclovir resistance in a cohort of patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. Prediction of cytomegalovirus load and resistance patterns after antiviral chemotherapy. Mutations conferring foscarnet resistance in a cohort of patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. Change over time in incidence of ganciclovir resistance in patients with cytomegalovirus retinitis. Phenotyping of cytomegalovirus drug resistance mutations by using recombinant viruses incorporating a reporter gene. Cytomegalovirus resistance to ganciclovir and clinical outcomes of patients with cytomegalovirus retinitis. Evaluation of the United States public health service guidelines for discontinuation of anticytomegalovirus therapy after immune recovery in patients with cytomegalovirus retinitis. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. Discontinuing anticytomegalovirus therapy in patients with immune reconstitution after combination antiretroviral therapy. Absence of teratogenicity of oral ganciclovir used during early pregnancy in a liver transplant recipient. Human cytomegalovirus reinfection is associated with intrauterine transmission in a highly cytomegalovirus-immune maternal population. The potential role of infectious agents as cofactors in human immunodeficiency virus infection. Congenital and perinatal cytomegalovirus infection in infants born to mothers infected with human immunodeficiency virus. Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants. Maternal human immunodeficiency virus infection and congenital transmission of cytomegalovirus. Obstetric factors and mother-to-child transmission of human immunodeficiency virus type 1: the French perinatal cohorts. Regression of fetal cerebral abnormalities by primary cytomegalovirus infection following hyperimmunoglobulin therapy. However, regardless of the clinical severity of infection, shedding on mucosal surfaces occurs frequently and can result in transmission. Classic manifestations include a sensory prodrome in the affected area, rapidly followed by the evolution of lesions from papule to vesicle, ulcer, and crust stages on the lip. Lesions recur 1 to 12 times per year and can be triggered by sunlight or physiologic stress. Typical genital mucosal or skin lesions evolve through stages of papule, vesicle, ulcer, and crust. Ulcerative lesions are usually the only stage observed on mucosal surfaces, but vesicles are commonly seen on genital skin (e. Mucosal disease is occasionally accompanied by dysuria or vaginal or urethral discharge. Inguinal lymphadenopathy is common with genital herpes, particularly in primary infection. Type-specific serologic assays are commercially available and can be used for diagnosis in asymptomatic individuals or those with atypical lesions. Guidelines for counseling are provided in the 2015 Centers for Disease Control and Prevention sexually-transmitted disease treatment guidelines. No laboratory monitoring is needed in patients receiving episodic or suppressive therapy unless they have advanced renal impairment. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. Genital herpes simplex virus infections: clinical manifestations, course, and complications. Correlation between response to acyclovir and foscarnet therapy and in vitro susceptibility result for isolates of herpes simplex virus from human immunodeficiency virus-infected patients. Knowledge of partners’ genital herpes protects against herpes simplex virus type 2 acquisition. Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex virus infection in the immunocompromised host. Increased risk of genital ulcer disease in women during the first month after initiating antiretroviral therapy. Reactivation of herpes simplex virus type 2 after initiation of antiretroviral therapy. A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. Valacyclovir for the suppression of recurrent genital herpes in human immunodeficiency virus-infected subjects. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984-1999. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Neonatal herpes disease following maternal antenatal antiviral suppressive therapy: a multicenter case series. Genital herpes simplex virus infection and perinatal transmission of human immunodeficiency virus. A person’s lifetime risk for herpes zoster is 15% to 20%, with the highest incidence occurring in the elderly and immunocompromised individuals. The rash is characterized by rapid evolution of lesions during the initial 8 to 12 hours and by successive crops of new lesions and by the presence of lesions in different stages of development at the same time. New vesicle formation continues for 2 to 4 days, accompanied by pruritus, fever, headache, malaise, and anorexia. Herpes zoster manifests as a painful cutaneous eruption in a dermatomal distribution, often preceded by prodromal pain. The most common sites for herpes zoster are the thoracic dermatomes (40%–50% of cases), followed by cranial nerve (20%–25%), cervical (15%–20%), lumbar (15%), and sacral (5%) dermatomes. Skin changes begin with an erythematous maculopapular rash, followed by the appearance of clear vesicles and accompanied by pain (which may be severe). New vesicle formation typically continues for 3 to 5 days, followed by lesion pustulation and scabbing.
The Detaining Power shall supply prisoners of war who work with such additional rations as are necessary for the labour on which they are employed purchase forzest 20mg fast delivery erectile dysfunction treatment bay area. Prisoners of war shall discount forzest 20mg herbal remedies erectile dysfunction causes, as far as possible, be associated with the preparation of their meals; they may be employed for that purpose in the kitchens. Furthermore, they shall be given the means of preparing, themselves, the additional food in their possession. Uniforms of enemy armed forces captured by the Detaining Power should, if suitable for the climate, be made available to clothe prisoners of war. In addition, prisoners of war who work shall receive appropriate clothing, wherever the nature of the work demands. The profits made by camp canteens shall be used for the benefit of the prisoners; a special fund shall be created for this purpose. The prisoners’ representative shall have the right to collaborate in the management of the canteen and of this fund. When a camp is closed down, the credit balance of the special fund shall be handed to an international welfare organization, to be employed for the benefit of prisoners of war of the same nationality as those who have contributed to the fund. In case of a general repatriation, such profits shall be kept by the Detaining Power, subject to any agreement to the contrary between the Powers concerned. Prisoners of war shall have for their use, day and night, conveniences which conform to the rules of hygiene and are maintained in a constant state of cleanliness. In any camps in which women prisoners of war are accommodated, separate conveniences shall be provided for them. Also, apart from the baths and showers with which the camps shall be furnished, prisoners of war shall be provided with sufficient water and soap for their personal toilet and for washing their personal laundry; the necessary installations, facilities and time shall be granted them for that purpose. Isolation wards shall, if necessary, be set aside for cases of contagious or mental disease. Prisoners of war suffering from serious disease, or whose condition necessitates special treatment, a surgical operation or hospital care, must be admitted to any military or civilian medical unit where such treatment can be given, even if their repatriation is contemplated in the near future. Special facilities shall be afforded for the care to be given to the disabled,in particular to the blind,and for their rehabilitation, pending repatriation. Prisoners of war shall have the attention, preferably, of medical personnel of the Power on which they depend and, if possible, of their nationality. Prisoners of war may not be prevented from presenting themselves to the medical authorities for examination. The detaining authorities shall, upon request, issue to every prisoner who has undergone treatment, an official certificate indicating the nature of his illness or injury, and the duration and kind of treatment received. A duplicate of this certificate shall be forwarded to the Central Prisoners of War Agency The costs of treatment, including those of any apparatus necessary for the maintenance of prisoners of war in good health, particularly dentures and other artificial appliances, and spectacles, shall be borne by the Detaining Power. They shall include the checking and the recording of the weight of each prisoner of war. Their purpose shall be, in particular, to supervise the general state of health, nutrition and cleanliness of prisoners and to detect contagious diseases, especially tuberculosis, malaria and venereal disease. In that case they shall continue to be prisoners of war, but shall receive the same treatment as corresponding medical personnel retained by the Detaining Power. They personnel shall, however, receive as a minimum the benefits and protection of the present Convention, and shall also be granted all facilities necessary to provide for the medical care of, and religious ministration to prisoners of war. They shall continue to exercise their medical and spiritual functions for the benefit of prisoners of war, preferably those belonging to the armed forces upon which they depend, within the scope of the military laws and regulations of the Detaining Power and under the control of its competent services, in accordance with their professional etiquette. They shall also benefit by the following facilities in the exercise of their medical or spiritual functions: a) They shall be authorized to visit periodically prisoners of war situated in working detachments or in hospitals outside the camp. For this purpose, the Detaining Power shall place at their disposal the necessary means of transport. For this purpose, Parties to the conflict shall agree at the outbreak of hostilities on the subject of the corresponding ranks of the medical personnel, including that of societies mentioned in Article 26 of the Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field of August 12, 1949. This senior medical officer, as well as chaplains, shall have the right to deal with the competent authorities of the camp on all questions relating to their duties. Such authorities shall afford them all necessary facilities for correspondence relating to these questions. During hostilities, the Parties to the conflict shall agree concerning the possible relief of retained personnel and shall settle the procedure to be followed. They shall be allocated among the various camps and labour detachments containing prisoners of war belonging to the same forces, speaking the same language or practising the same religion. They shall enjoy the necessary facilities, including the means of transport provided for in Article 33, for visiting the prisoners of war outside their camp. They shall be free to correspond, subject to censorship, on matters concerning their religious duties with the ecclesiastical authorities in the country of detention and with international religious organizations. Letters and cards which they may send for this purpose shall be in addition to the quota provided for in Article 71. For this purpose, they shall receive the same treatment as the chaplains retained by the Detaining Power. This appointment, subject to the approval of the Detaining Power, shall take place with the agreement of the community of prisoners concerned and, wherever necessary, with the approval of the local religious authorities of the same faith. The person thus appointed shall comply with all regulations established by the Detaining Power in the interests of discipline and military security. Prisoners shall have opportunities for taking physical exercise, including sports and games and for being out of doors. Such officer shall have in his possession a copy of the present Convention; he shall ensure that its provisions are known to the camp staff and the guard and shall be responsible, under the direction of his government, for its application. Prisoners of war, with the exception of officers, must salute and show to all officers of the Detaining Power the external marks of respect provided for by the regulations applying in their own forces. Officer prisoners of war are bound to salute only officers of a higher rank of the Detaining Power; they must, however, salute the camp commander regardless of his rank. Copies shall be supplied, on request, to the concerning prisoners who cannot have access to the copy which has been prisoners posted. Regulations, orders, notices and publications of every kind relating to the conduct of prisoners of war shall be issued to them in a language which they understand. Such regulations, orders and publications shall be posted in the manner described above and copies shall be handed to the prisoners’ representative. Every order and command addressed to prisoners of war individually must likewise be given in a language which they understand. The use of weapons against prisoners of war, weapons especially against those who are escaping or attempting to escape, shall constitute an extreme measure,which shall always be preceded by warnings appropriate to the circumstances. Titles and ranks which are subsequently created shall form the subject of similar communications. The Detaining Power shall recognize promotions in rank which have been accorded to prisoners of war and which have been duly notified by the Power on which these prisoners depend. In order to ensure service in officers’ camps, other ranks of the same armed forces who, as far as possible, speak the same language, shall be assigned in sufficient numbers, account being taken of the rank of officers and prisoners of equivalent status.
I. Givess. Hardin-Simmons University.