India is the epicenter of tropical fever diseases. Large numbers of cases are diagnosed with scrub typhus, leptospirosis, malaria, dengue, chikungunya, and enteric fever. Coinfections as an etiology of acute undifferentiated fever (AUF) have been recently recognized. The objective of this study was to assess the prevalence of coinfections in patients admitted with AUF in a tertiary-care hospital in the rural setting of Himachal Pradesh, India. Patients with coinfections as an etiology of AUF were the subjects of the study. The clinical records of patients diagnosed with confections between July 2018 and October 2018 were analyzed retrospectively in this hospital-based cross-sectional study. Standard protocol and guidelines were followed for the case definitions. Among total patients of 1005 with AUF, 14 (1.39%) patients were found to have coinfections. The most common coinfection was scrub typhus with leptospirosis and was diagnosed in seven (50%) patients. Other coinfections were scrub typhus with dengue in four (29%) and one patient each with scrub typhus and tubercular meningitis, scrub and influenza A (H1N1/2009) infection, and scrub and malaria (P. falciparum). Scrub typhus was the most common etiological diagnosis for the AUF and was observed in 159 (15.8%) patients. All the patients with coinfections had scrub typhus as the common infection. The prevalence of coinfections among scrub typhus patients constituted 8%. In tropical regions, coinfections are not very rare. High clinical suspicion for coinfections is required. Syndromic approach in the management is justified.

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Mature cystic teratoma is the most common benign ovarian tumour accounting for 20% cases among all ovarian neoplasm. It is a germ cell tumour. Malignant transformation of an epithelial component to squamous cell carcinoma is very rare phenomena accounting for only 2% of squamous cell carcinoma cases. In this case report, we are presenting two cases of squamous cell carcinoma arising in the mature cystic teratoma.Two women of age 62 and 47 years were presented to the gynaecology OPD with the complaints of distension and pain in the lower abdomen. On CECT abdomen of both the cases, there were solid cystic mass seen and the possibility of teratoma was suggested. On histopathologic examination, diagnosis of a mature cystic teratoma with a component of squamous cell carcinoma was offered.Mature cystic teratoma is frequently seen in young women. Malignant transformation in the setting of mature cystic teratoma is rare event and is more common among postmenopausal women. Malignant transformation in mature cystic teratoma carries a poor prognosis and need to be treated aggressively. Early diagnosis and adjuvant chemotherapy is the only way to increase the chances of survival of the patient. Mature cystic teratoma, especially if it is presenting in post-menopausal women is alarming and should be viewed with a high degree of suspicion as there are more chances of malignant transformation.

Anemia is a major concern during pregnancy especially in rural areas where females are nutrient deficient. Apart from nutritional deficiency there are many causes of anemia like anemia of chronic diseases, thalassemia, neoplasia etc. Many studies in the past revealed a correlation between blood groups and hemoglobin levels. In this study we have tried to establish the correlation between blood groups and hemoglobin among pregnant females in rural population of Himachal Pradesh. To find out the correlation of hemoglobin level and blood groups during pregnancy. Blood groups and hemoglobin levels are investigated during antenatal checkup. We have taken data of 120 pregnant females visited to the OPD for routine antenatal checkups. Among studied population A positive is the commonest blood group followed by B positive while anemia is most prevalent in B positive blood group. Anemia is a major concern among pregnant females as it effects the outcome of pregnancy. Many females have to go under caesarean section due to anemia related complications. So this study of correlation between blood groups and hemoglobin levels help to screen the pregnant females prone for anemia during first visit itself so that the treatment and the follow-up can be done as per the requirement of the patient.