Background: The purpose of this study is to determine the rates of bleeding associated with NOAC use. Methods: Patients diagnosed with venous thromboembolism (VTE) and treated with NOACs at a tertiary referral hospital in Kenya from January 2014 to December 2019 were recruited. They were followed up from commencement of oral anticoagulation to completion of therapy, the first major bleed, clinically relevant non-major bleed (CRNM), or minor bleeding. Data on bleeding was obtained from the hospital database and through telephone interviews. Unadjusted rates of the first major bleeding event or clinically relevant non-major bleeding (CRNM) were calculated as the number of bleeding events per 100 patient-years Results: Two hundred forty-three patients with VTE were recruited. 222(91.4%) were initiated on rivaroxaban, 12(4.9%) on dabigatran, 9(3.7%) on apixaban with a median follow-up of 213(119,477) days. The median age of the patients was 57(45, 71) years. A total of 64 bleeding events were identified in 41(16.9%) patients, 18.8 % were major, 17.2 % were clinically relevant non-major (CRNM), and 64.1 % were minor. The incidence rate for bleeding events was 22.1 per 100 patient-years. Gastrointestinal (GIT) bleeding was the most common major bleeding site. There were more females with bleeding events (70.7%) compared to males. Conclusions: In our cohort, most bleeding events were minor, with the GIT being the most common site of major bleeding and menorrhagia being the commonest cause of bleeding. Females had more major and CRNM than men.

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Background Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation and tissue destruction due to abnormal immune activation. HLH carries a very high mortality, and while delays in patients’ presentation to hospital, time to suspicion of HLH, investigation, and initiation of therapy all play a part, mortality remains high even with timely diagnosis and treatment. Classical manifestations of HLH include persistent fever, cytopenias, and liver dysfunction. Case presentation We present four cases of secondary HLH, highlighting the demographic and clinical characteristics of these patients, underlying triggers (including systemic lupus erythematosus, lymphoproliferative disorders, and leishmaniasis), together with challenges associated with the diagnosis and treatment of this rare disorder and a brief review of literature. Conclusion HLH has protean manifestations and requires a high index of suspicion as it can be a great clinical masquerader. Mortality due to multiorgan failure is often high even with early recognition and treatment.

Background:The purpose of this study is to determine the rates of bleeding associated with NOAC use. Methods:Patients diagnosed with venous thromboembolism (VTE) and treated with NOACs at a tertiary referral hospital in Kenya from January 2014 to December 2019 were recruited. They were followed up from commencement of oral anticoagulation to completion of therapy, the rst major bleed, clinically relevant non-major bleed (CRNM), or minor bleeding. Data on bleeding was obtained from the hospital database and through telephone interviews. Unadjusted rates of the rst major bleeding event or clinically relevant non-major bleeding (CRNM) were calculated as the number of bleeding events per 100 patient-years Results:Two hundred forty-three patients with VTE were recruited. 222(91.4%) were initiated on rivaroxaban, 12(4.9%) on dabigatran, 9(3.7%) on apixaban with a median follow-up of 213(119,477) days. The median age of the patients was 57(45, 71) years. A total of 64 bleeding events were identi ed in 41(16.9%) patients, 18.8 % were major, 17.2 % were clinically relevant non-major (CRNM), and 64.1 % were minor.The incidence rate for bleeding events was 22.1 per 100 patient-years. Gastrointestinal (GIT) bleeding was the most common major bleeding site. There were more females with bleeding events (70.7%) compared to males. Conclusions:In our cohort, most bleeding events were minor, with the GIT being the most common site of major bleeding and menorrhagia being the commonest cause of bleeding. Females had more major and CRNM than men. Key PointsMost of the patients were initiated on rivaroxaban Incidence rate of bleeding was 22.1 per 100 patient-years Gastrointestinal bleeding was the most common major bleeding site Females had more bleeding events than males Future clinical trials should include outcomes strati ed by sex, and further trials are needed to investigate the clinical impact of this sex-related safety difference