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To draw up evidence-based guidelines to make injections safer. A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005.

In a phase 3 trial involving more than 15,000 participants, two doses of NVX-CoV2373, a recombinant SARS-CoV-2 nanoparticle vaccine, administered 21 days apart had a vaccine efficacy of 89.7%. Reactogenicity was generally mild and transient, and adverse events were infrequent and of low grade.

Two doses 3 weeks apart of a lipid nanoparticle, nucleoside-modified RNA vaccine encoding a trimerized SARS-CoV-2 receptor–binding domain elicited high levels of antigen-binding and virus-neutralizing antibodies in adults 18 to 55 years and 65 to 85 years of age. Reactogenicity was moderate and transient. Large trials are ongoing.

Simplified treatment regimens for HIV management may increase adherence. In this open-label, randomized, controlled trial, longer-acting (monthly) injectable cabotegravir plus rilpivirine was compared with standard oral treatment. At 48 weeks, similar viral suppression was seen with the two regimens.

Antiviral medication has emerged as an important tool in the prevention of HIV infection. In this randomized, controlled trial, an injectable long-acting agent, cabotegravir, was found to be superior to daily oral tenofovir disoproxil fumarate–emtricitabine in preventing incident HIV infection in cisgender men and transgender women who have sex with men.

In this randomized, controlled trial involving more than 15,000 participants 50 years of age or older, a varicella–zoster virus subunit vaccine with AS01B adjuvant was found to have an efficacy of more than 96% in preventing herpes zoster. Herpes zoster, or shingles, results from the reactivation of latent varicella–zoster virus (VZV) in the dorsal-root or cranial-nerve ganglia, usually decades after primary infection. 1 , 2 Herpes zoster is characterized by a vesicular rash with a unilateral and dermatomal distribution and is almost always accompanied by pain. More than 90% of adults have been infected with VZV and are at risk for herpes zoster. 3 , 4 Although herpes zoster is most frequent in adults who are 50 years of age or older owing to immunosenescence, it can occur at any age, especially when cell-mediated immunity is decreased as a result of disease . . .

In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications. Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation. 1 – 3 The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data 4 , 5 and the belief that at a threshold of . . .

Ebola remains a global threat. In a randomized, controlled trial to assess the safety and immunogenicity of two vaccines against Ebola virus disease in Liberia, no safety signals were found. The vaccines elicited immune responses lasting at least 1 year.

Adverse events (AEs) after placebo treatment are common in randomized clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is important for COVID-19 vaccination worldwide especially because concern about AEs is reported to be a reason for vaccination hesitancy. To compare the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials with those reported in the vaccine groups. For this systematic review and meta-analysis, the Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched systematically using medical subheading terms and free-text keywords for trials of COVID-19 vaccines published up to July 14, 2021. Randomized clinical trials of COVID-19 vaccines that investigated adults aged 16 years or older were selected if they assessed solicited AEs within 7 days of injection, included an inert placebo arm, and provided AE reports for both the vaccine and placebo groups separately. Full texts were reviewed for eligibility by 2 independent reviewers. Data extraction and quality assessment were performed independently by 2 reviewers, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and using the Cochrane risk-of-bias tool. Meta-analyses were based on random-effects models. The primary outcomes were the proportions of placebo recipients reporting overall, systemic, and local (injection-site) AEs as well as logarithmic odds ratios (ORs) to evaluate group differences. Outcomes were tested for significance using z tests with 95% CIs. Twelve articles with AE reports for 45 380 participants (22 578 placebo recipients and 22 802 vaccine recipients) were analyzed. After the first dose, 35.2% (95% CI, 26.7%-43.7%) of placebo recipients experienced systemic AEs, with headache (19.3%; 95% CI, 13.6%-25.1%) and fatigue (16.7%; 95% CI, 9.8%-23.6%) being most common. After the second dose, 31.8% (95% CI, 28.7%-35.0%) of placebo recipients reported systemic AEs. The ratio between placebo and vaccine arms showed that nocebo responses accounted for 76.0% of systemic AEs after the first COVID-19 vaccine dose and for 51.8% after the second dose. Significantly more vaccine recipients reported AEs, but the group difference for systemic AEs was small after the first dose (OR, -0.47; 95% CI, -0.54 to -0.40; P < .001; standardized mean difference, -0.26; 95% CI, -0.30 to -0.22) and large after the second dose (OR, -1.36; 95% CI, -1.86 to -0.86; P < .001; standardized mean difference, -0.75; 95% CI, -1.03 to -0.47). In this systematic review and meta-analysis, significantly more AEs were reported in vaccine groups compared with placebo groups, but the rates of reported AEs in the placebo arms were still substantial. Public vaccination programs should consider these high rates of AEs in placebo arms.

ABSTRACT Aims Compensatory masseteric bulging, a newly identified complication, arises from repeated botulinum neurotoxin injections targeting the lower mid‐masseter in East Asians. This phenomenon occurs when untreated upper muscle layers hypertrophy to compensate for weakened lower regions, disrupting facial symmetry. Traditional injection strategies, focused on the lower muscle bulk, overlook the masseter's complex three‐layered anatomy (superficial, middle, deep), increasing asymmetry risks. Methods To prevent compensatory bulging, a retrograde, layered injection technique is proposed, distributing botulinum neurotoxin evenly across the upper, middle, and lower masseter. Ultrasound guidance enhances precision, ensuring toxin delivery to targeted layers while avoiding diffusion into adjacent muscles (e.g., risorius). Personalized dosing, adjusted for muscle thickness, activity, and treatment history, minimizes localized over‐atrophy. Results A 34‐year‐old female developed upper masseter bulging after four lower mid‐masseter botulinum toxin sessions over two years. Ultrasound revealed upper hypoechoic hypertrophy (12 mm thickness) contrasting with lower hyperechoic atrophy (5 mm). Injecting 50 units of LetibotulinumtoxinA into the upper masseter reduced hypertrophy (8 mm post‐treatment), restoring facial symmetry. Discussion Compensatory bulging underscores the need for holistic treatment addressing the entire muscle. Layered injections, guided by ultrasound and tailored dosing, mitigate asymmetry risks. Clinicians must adopt comprehensive strategies, integrating anatomical insights and advanced imaging, to optimize aesthetic outcomes in masseter hypertrophy management.