Diffuse idiopathic skeletal hyperostosis (DISH): Detection on dental radiologic examinations in two older adults and overview of the literature.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is a potentially serious osteopathic disorder associated with coalescing ossifications of the anterior vertebrae and may be concomitant with a constellation of symptomatology and systemic comorbidities. There is limited dental literature describing this finding on panoramic radiographs and cone beam computed tomography (CBCT) scans. CASE PRESENTATIONS: Two case reports of DISH are provided. One patient manifested extensive ossifications along the cervical vertebrae and consequent episodes of dysphagia and hoarseness. The other affected patient's cervical ossification was found at an earlier stage of formation and without symptomatology. Panoramic radiography, cervical spine radiography, and CBCT examinations have been provided. CONCLUSION: Attending dental healthcare practitioners should carefully evaluate all areas of interest and surrounding fields of view when taking panoramic radiographs and CBCT scans for manifestations of DISH and other potential disorders of the cervical vertebrae. A suspected radiologic finding of DISH should prompt timely referral for comprehensive medical assessment to mitigate neurologic deficits and other comorbidities.

A comparative analysis of gastrointestinal tract barrier function and immune markers in gilt vs. sow progeny at birth and weaning.

Progeny born to primiparous sows (gilt progeny; GP) have lower birth, weaning and slaughter weights than sow progeny (SP). GP also have reduced gastrointestinal tract (GIT) development, as evidenced by lower organ weights. Therefore, the aim of this experiment was to quantify changes in GIT barrier function that occur in birth and weaning, representing two major challenges to the young piglet. The effects of parity (GP vs. SP) in GIT barrier integrity function were quantified at four timepoints: birth (~0 h), 24 h after birth (24 h), 1-d preweaning (PrW), and 1-d postweaning (PoW) in commercially reared piglets. Due to inherent differences between newborn and weanling pigs, the results were analyzed in two cohorts, birth (0 vs. 24 h, n = 31) and weaning (PrW vs. PoW, n = 40). Samples of the stomach, jejunum, ileum, and colon were excised after euthanasia and barrier integrity was quantified by measuring transepithelial resistance (TER), macromolecular permeability, the abundance of inflammatory proteins (IL-8, IL-1ß, and TNF-α) and tight junction proteins (claudin-2 and -3). Papp was characterized using a dual tracer approach comprising 4 KDa fluorescein isothiocyanate (FD4) and 150 kDa tetramethyl rhodamine isothiocyanate (T150)-labeled dextrans. Characteristic effects of the initiation of feeding and weaning were observed on the GIT with the initiation of feeding, such as increasing TER and reducing Papp at 24 h, consistent with mucosal growth (P = 0.058) This was accompanied by increased cytokine abundance as evidenced by elevations in TNF-α and IL-1ß. However, GP had increased IL-8 abundance (P = 0.011 and 0.063 for jejunum and ileum respectively) at birth than 24 h overall. In the weaning cohort, jejunal and ileal permeability to FD4 was higher in GP (P = 0.05 and 0.022, respectively) while only higher ileal T150 was observed in GP (P = 0.032). Ileal claudin-2 abundance tended to be higher in SP overall (P = 0.063), but GP ileal claudin-2 expression was upregulated weaning while no change was observed in SP (P = 0.043). Finally, other than a higher jejunal TNF-α abundance observed in SP (P = 0.016), no other effect of parity was observed on inflammatory markers in the weaning cohort. The results from this study indicate that the GIT of GP have poorer adaptation to early life events, with the response to weaning, being more challenging which is likely to contribute to poorer postweaning growth.

The progeny of primiparous sows (gilt progeny; GP) have poorer lifetime growth performance in comparison to progeny from multiparous sows (sow progeny; SP). Previous research suggests that there is an underlying biological basis for reduced growth performance which is attributed to differences in gastrointestinal tract (GIT) barrier development during early life. This study aimed to clarify the timeframes of when these differences are in effect by investigating GIT development during two major events of a piglet's life: birth and weaning. To do this, GIT tissue was collected from GP and SP at four time points; birth, 24 h after birth, 1-d preweaning, and 1-d postweaning and assessed for functional development. The main findings from this study indicate there are early signs of variation in GIT development within the first 24 h of life between GP and SP, and that these differences increase through the preweaning period, with GP entering weaning with poorer GIT development and function. Possible explanations for the reduced GI development may be reduced maternal nutrition during the suckling period.

Correction: Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review.

[This corrects the article DOI: 10.1371/journal.pgph.0001526.].

Associations between Surface and Rectal Temperature Profiles of Low-Birth-Weight Piglets.

The use of infrared cameras to record surface temperature has shown some promise in older pigs, but neonatal piglets are metabolically less mature and experience rapid temperature changes during their first 24 h. The present experiment aimed to compare rectal temperature to surface temperature at the base of the ear, measured using an infrared camera, for piglets of different birth weights. During farrowing, 48 multiparous sows were monitored, and rectal and surface temperatures were recorded for their lower-birth-weight (≤1.2 kg) piglets within 3 min of birth and at 0.25, 0.50, 0.75, 1, 1.25, 1.50, 2, 3, 4, and 24 h. Piglet birth weights were assigned to one of three categories (BWC): BWC1 (≤0.80 kg), BWC2 (0.81 to 1.10 kg), or BWC3 (1.11 to 1.20 kg). Piglet rectal temperatures at 1.25 h after birth were assigned to one of three categories: RC1 (≤32.0 °C), RC2 (32.1 to 35.0 °C), or RC3 (≥35.1 °C). Surface temperatures showed a similar recovery pattern to rectal temperatures in the first 24 h across all piglet birth weights, although large and variable differences seen in the current study militate against surface temperature being an appropriate replacement for neonatal rectal temperature for use in production.

The Association Between Adverse Childhood Experiences and Different Types of Offending Behavior: An Examination Across Two Generations of British Males.

Research has established a relationship between trauma exposure, often conceptualized as Adverse Childhood Experiences (ACEs), and offending, with some evidence suggesting that both trauma and offending can be transmitted from one generation to the next. Further, while some evidence suggests that experiencing a high number of ACEs is associated with different types of offenses, it is not known whether these associations are similar across generations. The current study aims to address this gap in knowledge by examining the effects of ACEs on different offense types across two generations, utilizing data from a longitudinal study of British male participants and their male children. Results suggest that high ACE scores are associated with several offense types within generations, but the effect of parental ACEs on the subsequent generation's offending was weak. Alongside a discussion of these findings, study limitations and future research directions are also presented.

Behavior-change interventions to improve antimicrobial stewardship in human health, animal health, and livestock agriculture: A systematic review.

Antimicrobial resistance (AMR) is an economic, food security, and global health threat accelerated by a multitude of factors including the overuse and misuse of antimicrobials in the human health, animal health, and agriculture sectors. Given the rapid emergence and spread of AMR and the relative lack of development of new antimicrobials or alternative therapies, there is a need to develop and implement non-pharmaceutical AMR mitigation policies and interventions that improve antimicrobial stewardship (AMS) practices across all sectors where antimicrobials are used. We conducted a systematic literature review per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify peer-reviewed studies that described behavior-change interventions that aimed to improve AMS and/or reduce inappropriate antimicrobial use (AMU) among human health, animal health, and livestock agriculture stakeholders. We identified 301 total publications- 11 in the animal health sector and 290 in the human health sector-and assessed described interventions using metrics across five thematic areas- (1) AMU, (2) adherence to clinical guidelines, (3) AMS, (4) AMR, and (5) clinical outcomes. The lack of studies describing the animal health sector precluded a meta-analysis. Variation across intervention type, study type, and outcome precluded a meta-analysis for studies describing the human health sector; however, a summary descriptive analysis was conducted. Among studies in the human health sector, 35.7% reported significant (p<0.05) pre- to post-intervention decreases in AMU, 73.7% reported significant improvements in adherence of antimicrobial therapies to clinical guidelines, 45% demonstrated significant improvements in AMS practices, 45.5% reported significant decreases in the proportion of isolates that were resistant to antibiotics or the proportion of patients with drug-resistant infections across 17 antimicrobial-organism combinations. Few studies reported significant changes in clinical outcomes. We did not identify any overarching intervention type nor characteristics associated with successful improvement in AMS, AMR, AMU, adherence, nor clinical outcomes.

Trends of clandestine laboratories manufacturing methamphetamine in New Zealand between 2009-2021: Evolution, enforcement, legislative, and COVID-19 effects.

The most common method of domestic methamphetamine manufacture encountered in New Zealand is the hydrogen iodide (HI) reduction of pseudoephedrine/ephedrine. While the overall method used to manufacture methamphetamine has remained consistent, the processes and chemicals utilized have evolved. Understanding the reason for any changes to methamphetamine manufacturing trends can assist jurisdictions with predicting the potential effects of enforcement and legislative initiatives. This paper presents data and trends amassed from suspected clandestine laboratories, associated with the manufacture of methamphetamine, in New Zealand between 2009 and 2021, along with data on methamphetamine, pseudoephedrine, and ephedrine seizures at the border. The data have shown that clandestine manufacturers in New Zealand have evolved the methamphetamine manufacturing process over the years. These changes in trends can largely be attributed to various enforcement and legislative effects and the COVID-19 pandemic response. Effects that enforcement, legislation, and the COVID-19 pandemic response may have had on the precursors, chemicals and equipment encountered are discussed.

Empathy and Cognitive Distortions in Sex Offenders Participating in Community Based Treatment.

This study examined the relationship between empathy as measured by the Empathy Index (EI) and the Cognitive Distortion Scale (CDS) among a sample (N = 151) of individuals who committed sexual offenses who were receiving community-based sex offender treatment in a large southern state. The extent to which the relationships by age was also considered. The findings indicated a weak but significant positive correlation between total empathy and each of the cognitive distortion scales, and a similar positive correlation between the instrumental aggression empathy subscale and the three cognitive distortion scales. Furthermore, these findings suggested that those with lower empathy were more likely to have cognitive distortions than those with higher empathy. Recommendations for future research and implications for treatment are provided.

Clustering of adverse and positive childhood experiences: The nature and correlates of risk and protective factors.

BACKGROUND: Despite the increased attention paid to the separate effects of cumulative stress and protection on offending, the extent to which distinct clusters of risk and protective factors exist and have unique effects on justice-related outcomes is under-studied. OBJECTIVE: The current study examines for unique clustering of Adverse Childhood Experiences (ACE) and Positive Childhood Experiences (PCE) and the extent to which they predict juvenile recidivism. PARTICIPANTS AND SETTING: The sample consists of a cohort of youth adjudicated delinquent in Florida who received a community-based sanction. METHODS: The study first utilized latent-class analysis to identify distinct classes based upon the youths' ACE and PCE exposures. Next, two sets of regression models were estimated; the first investigated correlates of class membership and the second assessed whether class membership predicted recidivism. RESULTS: Seven distinct classes of ACE/PCE clusters were found, composing 9.9 % to 20.5 % of the sample each. Relative to the class with low ACE and low PCE, those with low ACEs and high PCE evidenced 27.5 % lower rearrest rates, as did the Moderate Risk/Moderate Protection group. CONCLUSIONS: Not only do distinct groupings of ACE and PCE exposures exist, but these groups have different likelihoods of future offending, where a youth's cumulative protection appears to be more important than their risk level. This has important policy implications as it offers further support for the use of strength-based treatment approaches.

Salivary Steroid Collection in Children Under Conditions Replicating Home Sampling.

CONTEXT: Measurement of salivary glucocorticoids is an accepted method for testing adrenal function but there are few data on stability during home collection. Current salivary collection techniques require active participation or present a choking hazard and are unsuitable for young children. OBJECTIVE: We sought to compare different salivary collection methods; assess the stability of salivary glucocorticoids under conditions replicating home collection; and assess patient tolerability and caregiver acceptability of a salivary collection device for young children, a swab encased in an infant pacifier (SaliPac). METHODS: Six healthy adults collected salivary samples using a Salivette Cortisol, passive drool, and SalivaBio at night, waking, and 3 Pm for five days. Time to collect 1-mL saliva using the SalivaBio and SaliPac and caregiver acceptability were assessed in 30 children younger than 6 years. Saliva was stored at 4 °C, room temperature (RT), and 50 °C for 24, 48, 72 hours and 1 week to replicate potential postage conditions. Salivary cortisol and cortisone concentrations were measured by mass spectrometry. RESULTS: There was no difference in salivary glucocorticoid concentrations using the 3 collection methods. Salivary cortisol and cortisone were stable for 72 hours at RT and 4 °C, and repeated freeze-thaw cycles did not cause significant degradation. In children younger than 6 years the SalivaBio and SaliPac were well tolerated and collected sufficient saliva for salivary steroid analysis in less than 4 minutes. CONCLUSION: Salivette, passive drool, and SalivaBio collect samples with comparable salivary cortisol and cortisone concentrations, which are stable under conditions replicating home collection. SaliPac is an acceptable device for salivary sampling in young children.

Increased feeding frequency prior to farrowing: effects on sow performance.

Reducing the interval between the consumption of the last meal and the start of farrowing is suggested to increase the energy available to sows during farrowing, potentially reducing the farrowing duration and easing piglet births. The present study aimed to examine whether increasing feeding frequency from one to two feeds within standard production hours (0700 to 1500 hours) would produce a difference in farrowing duration and/or stillborn numbers. From entry to farrowing crates (110 ± 1 d gestation) to farrowing (116 ± 1 d gestation), multiparous sows (n = 118) were fed a daily fixed amount of feed either once at 0800 hours or in two meals at 0800 and 1300 hours. Sow weights and backfat depths were recorded on entry and exit from the farrowing crate. Litter size and weight were recorded 24 h after farrowing and on day 21 of lactation. Sows fed twice had a shorter farrowing duration and fewer stillborn piglets than those fed once (2.21 ± 0.56 h vs. 3.25 ± 0.52 h; P = 0.001). The interaction between treatment and farrowing duration showed that sows fed twice have a reduced farrowing duration and had significantly lower stillborn rates than those fed once or those fed twice with longer farrowing durations (P < 0.001). These findings suggest that increasing feeding frequency prior to farrow can reduce the farrowing duration and stillborn numbers in some sows, however, some sows remain with a high stillborn rate regardless of feeding frequency. Piglet average daily gain was greater in once-fed sows, but fewer of these sows remained in the herd at subsequent farrowing. Further, subsequent total born and born alive were higher in twice-fed sows. Feeding sows at a higher frequency can improve farrowing performance in some sows and could increase the longevity of the sow in the herd.

Piglet Morphology: Indicators of Neonatal Viability?

The morphological measures, crown-to-rump length (CR), and abdominal circumference (AC) have been suggested to be as good, if not better, than birth weight for predicting piglet performance. We explored the relationships between CR and AC, and piglet weights at birth and 24 h, to investigate their predictive value for piglet survival. Piglet weight and AC at birth and 24 h, and CR at 24 h were recorded for 373 piglets born to 31 sows. Morphological measures were categorised into two levels for weight and three levels for AC and CR. Further, AC and CR groupings were concatenated to create a new variable (PigProp) to describe the proportionality of piglet morphology. Proportionate piglets had equal CR and AC levels, and disproportionate piglets had contrasting levels. Birth AC was a good predictor of colostrum intake (p < 0.001) when accounting for birth weight, but 24 h weight and PigProp were good indicators of actual colostrum intake (p < 0.001 for both). The significant interaction of colostrum and PigProp showed that within the smaller piglet groups, those who had greater than 200 g of colostrum had higher 24 h weight and survival (p < 0.001 both). As expected, as body weight and colostrum intake increased, so did weight change to d 21 (P = 0.03 and trend at p = 0.1, respectively). A similar pattern was seen with increasing PigProp group (p < 0.001); however, piglets from the disproportionate group 1,3 had the greatest observed weight change (5.15 ± 0.06 kg). Our data show morphological measures may be more predictive of piglet viability in terms of both performance and survival than weight and there may be subgroups that have higher than expected chances of survival.

Comparison of national antimicrobial treatment guidelines, African Union.

OBJECTIVE: To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States. METHODS: We reviewed national government agency and public health institutes' websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines. FINDINGS: We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes. CONCLUSION: AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.

Piglet Viability: A Review of Identification and Pre-Weaning Management Strategies.

Increased attention on the effects of the global push for a larger litter size has focused on the increased occurrence of piglets with decreased viability, which have lighter birthweights and a reduced ability to thrive in early life. To improve their odds of survival, interventions must be timely and targeted. This requires the early identification of low-viability pigs and appropriate strategies to manage them. Using novel measures such as abdominal circumference and crown to the rump length in conjunction with birth weight may provide an improved protocol for the identification of those at most risk of preweaning mortality. Further, identifying these at-risk piglets allows interventions to increase their colostrum intake and heat provisions shortly following birth. The appropriate management of the pre- and post-partum sows will improve the chances of decreasing the number of piglets born with lower viability. However, this outcome is constrained by limitations in resources such as technology and staffing. If these challenges can be overcome, it will allow for greater control and increased effectiveness in the implementation of current and new management strategies.

Compensatory feeding during early gestation for sows with a high weight loss after a summer lactation increased piglet birth weight but reduced litter size.

Sows mated in summer produce a greater proportion of born-light piglets (<1.1 kg) which contributes to increased carcass fatness in the progeny population. The reasons for the low birth weight of these piglets remain unclear, and there have been few successful mitigation strategies identified. We hypothesized that: 1) the low birth weight of progeny born to sows mated in summer may be associated with weight loss during the previous summer lactation; and 2) increasing early gestation feed allowance for the sows with high lactational weight loss in summer can help weight recovery and improve progeny birth weight. Sows were classified as having either low (av. 1%) or high (av. 7%) lactational weight loss in their summer lactation. All the sows with low lactational weight loss (LLStd) and half of the sows with high lactational weight loss received a standard gestation feeding regime (HLStd) (2.6 kg/d; day 0-30 gestation), whereas the rest of the sows with high lactational weight loss received a compensatory feed allowance (HLComp) (3.5 kg/d; day 0-30 gestation). A comparison of LLStd (n = 75) versus HLStd sows (n = 78) showed that this magnitude of weight loss over summer lactation did not affect the average piglet or litter birth weight, but such results may be influenced by the higher litter size (P = 0.030) observed in LLStd sows. A comparison of HLStd versus HLComp (n = 81) sows showed that the compensatory feeding increased (P = 0.021) weight gain of gestating sows by 6 kg, increased (P = 0.009) average piglet birth weight by 0.12 kg, tended to reduce (P = 0.054) the percentage of born-light piglets from 23.5% to 17.1% but reduced the litter size by 1.4 (P = 0.014). A subgroup of progeny stratified as born-light (0.8-1.1 kg) or -normal (1.3-1.7 kg) from each sow treatment were monitored for growth performance from weaning until 100 kg weight. The growth performance and carcass backfat of progeny were not affected by sow treatments. Born-light progeny had lower feed intake, lower growth rate, higher G:F, and higher carcass backfat than born-normal progeny (all P < 0.05). In summary, compensatory feeding from day 0 to 30 gestation in the sows with high weight loss during summer lactation reduced the percentage of born-light progeny at the cost of a lower litter size, which should improve growth rate and carcass leanness in the progeny population born to sows with high lactational weight loss.

Modelling COVID-19 transmission in Africa: countrywise projections of total and severe infections under different lockdown scenarios.

OBJECTIVES: As of 13 January 2021, there have been 3 113 963 confirmed cases of SARS-CoV-2 and 74 619 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policymaking decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios. DESIGN: We developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown and hard lockdown with continued restrictions once lockdown is lifted. We further analysed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and tuberculosis (TB). RESULTS: In the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645 081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa, projected peak severe infections increase from 162 977 to 2 03 261, when vulnerable populations with HIV/AIDS and TB are included in the analysis. CONCLUSION: The COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policymakers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives.

Exposures in nail salons to trace elements in nail polish from impurities or pigment ingredients - A pilot study.

Nail polishes have evolved considerably. Toxic elements, such as lead, have been found in nail polish, and it is unclear if new finishes using metallic effect pigments may be contributing to metals exposure in nail technicians. We characterized concentrations of trace elements in 40 nail polishes, 9 technicians' urine, and 20 technicians' toenail clippings from 8 nail salons in the Boston area in 2017. We also collected 24 salon surface wipes from 3 of the salons. Antimony was not disclosed as a nail polish ingredient, yet concentrations (<15 µg/g) were above existing cosmetics guidelines (0.5 µg/g) in five (13%) of the samples. Aluminum (<11,450 µg/g), barium (<11,250 µg/g), iron (<3,270 µg/g), and magnesium (<2375 µg/g) were disclosed as ingredients and were also found on salon surfaces where nail polish was stored or used. Heavy metal impurities in nail polish were not detected for cadmium. Lead and nickel were found at low concentrations (<0.40 µg/g lead, <0.67 µg/g nickel). Tin (p = 0.003) concentrations were higher in nail polish with finishes compared to without. Barium and strontium (both p = 0.0001) concentrations were higher for red nail polishes compared to all other colors. Of those elements in nail polish and salon surfaces, aluminum and iron were detected in toenails, manganese was detected in urine and toenails, and barium was detected in urine at comparable levels to the general population. Besides preventable antimony levels in nail polish, individual metals in nail polish did not appear to be from impurities but mainly from colorants (i.e., pigments) and not major contributors to nail technician exposure. It is unclear if low-level chronic metals mixtures in nail salons are of health concern.

Development of the first edition of African treatment guidelines for common bacterial infections and syndromes.

Standard treatment guidelines (STGs) are an important tool for ensuring high quality clinical care and prudent antimicrobial use (AMU) and stewardship (AMS). In 2018, African Union (AU) member state representatives recognized the lack of STGs as a barrier to AMS at national and facility levels. Previous research reported that only 17 of 55 (31%) member states had STGs that provided disease- or pathogen-specific antimicrobial treatment recommendations, excluding those that covered only treatment of HIV, malaria, and tuberculosis). The Africa Centres for Disease Control and Prevention convened expert panels to develop first edition antibiotic treatment guidelines for priority infectious diseases and clinical syndromes for pediatric and adult patient populations in Africa. The purpose of the guidelines is to provide healthcare workers with treatment guidance by harmonising existing national STGs, filling gaps where existing STGs are not available, and serving as a model for future guidelines. Two expert panels of 28 total clinicians, pharmacists, and other relevant stakeholders from 14 AU member states representing each continental region convened to develop consensus treatment recommendations for select priority bacterial infections and clinical syndromes. In developing recommendations, the panels considered treatment recommendations from existing STGs, drug availability, clinical experience, and available antimicrobial resistance data. The guidelines underwent an external review process where clinical stakeholders who did not serve on either panel were invited to submit feedback prior to their publication. The guidelines provide empiric antibiotic therapy guidelines - including drug selection, route of administration, formulation, dosage, and therapy duration - and principles of stewardship for 28 bacterial infections or clinical syndromes. The first edition guidelines for the treatment of common infectious diseases and clinical syndromes in Africa aims to improve clinical treatment and antimicrobial stewardship and will serve as a template for future regional guidelines.