East Africa University

Potassium citrate is widely used as oral alkali therapy for the prevention of recurrent nephrolithiasis. Despite its long-standing clinical use, systematically collected real-world safety data remain limited. We performed a pharmacovigilance analysis to characterize adverse event reports associated with potassium citrate using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). FAERS reports submitted between 2014 and 2025 listing potassium citrate as the primary suspect drug were analyzed. Duplicate records were removed, and adverse events were coded using the Medical Dictionary for Regulatory Activities (MedDRA) at both the system organ class and standardized event term levels (preferred terms, PTs). Disproportionality analyses were conducted using reporting odds ratio, proportional reporting ratio, bayesian confidence propagation neural network, and multi-item gamma poisson shrinker methods. A total of 408 unique reports were included. Most reports involved adults and were physician-reported from the United States. Disproportionality analysis identified potential safety issues (signals), defined as drug event associations reported more frequently than expected in FAERS and therefore warranting further evaluation, although not establishing causality. The strongest associations involved product-related issues, laboratory investigations, and gastrointestinal disorders. When these potential safety issues were described using standardized MedDRA event terms most reflected formulation- and administration-related problems, including tablet residue in stool, abnormal solubility, swallowing difficulty, throat irritation, and foreign body sensations. Reports of rash were infrequent. This first FAERS-based analysis of potassium citrate highlights that most reported adverse events are related to formulation and administration characteristics rather than drug toxicity. These findings support the overall tolerability of potassium citrate while underscoring the importance of adherence, patient education, and formulation-specific considerations in clinical practice. As a spontaneous reporting system, FAERS is valuable for hypothesis generation, label expansion, and post-marketing surveillance, but it is not suitable for estimating the incidence or absolute risk of adverse events.

Dromedary camels are the main reservoir for Middle East respiratory syndrome coronavirus (MERS-CoV), a re-emerging infectious disease with pandemic potential. Somalia harbours approximately 32% of dromedary camels globally. We investigated current and past MERS-CoV infections among occupationally-exposed workers in slaughterhouses, dairy farms, livestock markets and a quarantine station. Sera and nasopharyngeal/oropharyngeal swabs from 770 workers were analysed for MERS-CoV antibodies by Enzyme-Linked Immunosorbent Assay (ELISA) and virus neutralization and for viral RNA by Real Star MERS-CoV Reverse Transcription Polymerase Chain Reaction (RT-PCR). One farm worker with no travel history in the Qardo district, Karkar region, Puntland was sero-positive by ELISA and virus neutralization, providing the first-ever evidence of zoonotic spillover of MERS-CoV to humans in Somalia. This finding highlights the need to strengthen MERS-CoV surveillance across Somalia, along with an urgent need to strengthen national laboratory capacity and integrate MERS into diagnostic algorithms to generate accurate and reliable infection data and studies to understand the socio-cultural and potential risk factors for MERS-CoV. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was supported by WHO and funded by GIZ One Health (grant number 81278362). RM acknowledges funding from the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (MR/X020258/1) funded by the UK MRC and carried out in the frame of the Global Health EDCTP3 Joint Undertaking supported by the EU. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical Clearance was approved from the East Africa University Research Ethical Review Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data may be available upon reasonable request to the corresponding authors.

Accurate assessment of stone burden is fundamental in urolithiasis, as it directly influences treatment selection and prognostic evaluation. Although maximum stone diameter on non-contrast computed tomography remains the most widely used parameter, it does not adequately reflect the three-dimensional complexity of urinary calculi. This review aimed to summarize the evolution of stone burden assessment from conventional imaging-based methods to software-assisted volumetry and artificial intelligence (AI)-driven tools, with emphasis on their accuracy, reproducibility, and clinical utility. A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Google Scholar for English-language studies published up to March 2026. Original studies, validation studies, technical reports, reviews, and guideline-related papers addressing conventional CT-based measurement, software-assisted volumetry, AI-based stone segmentation, and the clinical significance of stone volume were included. Due to heterogeneity in study design and reported outcomes, the evidence was synthesized narratively. Maximum stone diameter remains simple and widely available, but it incompletely represents true stone burden, particularly in larger or irregular stones. Formula-based ellipsoid calculations are practical yet show limited accuracy in complex geometries. Semi-automated CT-based segmentation software provides more reliable volumetric assessment, with excellent agreement with reference standards and reduced interobserver variability. AI-based approaches have further improved efficiency by enabling rapid and highly accurate automated stone detection and volume calculation. Across the reviewed literature, stone volume was consistently shown to be more clinically informative than linear dimensions for predicting spontaneous passage, stone-free rates after shockwave lithotripsy and ureteroscopy, and future symptomatic events during surveillance. Stone volume offers a more accurate and clinically meaningful estimate of stone burden than maximum stone diameter alone. The transition from formula-based methods to software-assisted and AI-driven volumetry represents an important advance in urolithiasis imaging. Wider adoption will depend on standardized imaging protocols, improved software accessibility, and validation of volume-based thresholds for routine clinical practice.

BACKGROUND:Somalia has one of the highest maternal mortality ratios and low coverage of maternal health services. Evidence on socioeconomic and geographic inequalities across maternal care continuum remains limited. OBJECTIVE:This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia. METHODS:We analysed data from the 2020 Somali Health and Demographic Survey (SHDS), including 8,598 ever-married women aged 15-49 years with a recent live birth. Outcomes were at least one antenatal care visit (ANC), health facility childbirth, and postnatal care (PNC) within 2 days of birth. Multilevel mixed-effects logistic regression examined associations with socioeconomic, geographic, and empowerment-related factors, while Erreygers Concentration Indices (ECIs) assessed wealth-related inequalities. Results are presented as adjusted odds ratios (aORs), ECIs, and 95% confidence intervals (CIs). RESULTS:Coverage was low: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received PNC. Nomadic women were less likely to deliver in a health facility (aOR = 0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR = 0.49; 95% CI: 0.32, 0.75). Rural residence, the Northeastern and Southcentral zones, and higher parity were associated with lower service utilisation, whereas higher education, mobile phone ownership, household wealth, and media exposure increased utilisation. Pro-rich inequalities were observed for ANC (ECI: 0.40), health facility childbirth (ECI: 0.38), and early PNC (ECI: 0.19). CONCLUSIONS:Maternal health service utilisation remains critically low with socioeconomic and geographic inequalities. Equity-focused strategies targeting rural, remote, and nomadic populations are needed to accelerate universal health coverage.