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Post-transplant malignancy is one of the contentious and feared consequences of Solid Organ Transplantation (SOT), which might detrimentally alter the outcome of transplantation. Risk factors are manifold, principally related to a suppressed immune system with intercurrent immunosuppressant medications commonly used in the context of SOT. Opportunistic viral infections encountered in SOT are crucial promoters of mitogenic proliferation in several common tumors. Lastly, immune suppressant therapy might trigger mitogenic changes directly.In this paper, we are discussing post-SOT malignancies, elaborating on the different phases of its pathogenesis, and elucidating on the different aspects that linger in its risk factors, preventive strategies, and management.

Background: Outcomes of chemotherapy in adults with ALL in resource-poor countries are reportedly worse compared with outcomes in resource-rich countries. There are few comparative data on transplants in these settings.Methods: Retrospective analysis of 102 consecutive subjects > 18 years with ALL receiving an allotransplant from Jan 2007 to Sept 2022 in Jordan.Results: Median follow-up is 38 mo ([IQR] 16-80 mo). 81 subjects were men. The median age was 29 y(IQR 22-36 y). 63 were B-cell and 38, were T-cell lineage. 31 had the Ph-chromosome. 68 were in 1st and 34, ≥ 2nd histological complete remission. 97 received intensive conditioning. Donors were an HLA-identical sibling (N = 88) or an HLA-mis-matched relative (N = 14). Grafts were blood cells. Subjects received conventional GvHD prophylaxis, cyclophosphamide (N = 11) or ATG (N = 3). All subjects recovered bone marrow function with complete donor chimerism. 5-year leukemia-free survival (LFS), 58% (47, 69%) and survival, 45% (34, 56%). 45 subjects developed acute and 44, cGvHD. 3-year cumulative incidence of cGvHD was 28% (15, 42%). 5-year CIR was 32% (18, 45%) and 3-year NRM, 25% (15, 35%).Conclusion: Allotransplant outcomes in adults with ALL in Jordan, a resource-poor country, seem comparable to those reported in resource-rich countries.

Stroke is a clinically defined syndrome of acute focal neurological deficit attributed to vascular injury (infarction, hemorrhage) of the central nervous system. Stroke is the second leading cause of death and disability worldwide. Stroke is not a single disease but can be caused by a wide range of risk factors, disease processes and mechanisms. Approximately 15% of strokes worldwide are the result of intracerebral hemorrhage, which can be deep (basal ganglia, brainstem), cerebellar or lobar. A minority (about 20%) of intracerebral hemorrhages are caused by macrovascular lesions (vascular malformations, aneurysms, cavernomas), venous sinus thrombosis or rarer causes.

Dyspepsia refers to acute, chronic, or recurrent pain or discomfort centered in the upper abdomen. An international committee of clinical investigators (Rome III Committee) has defined Dyspepsia as Epigastric pain or Burning, early satiety, or postprandial fullness Dyspepsia occurs in 15 % of the Adult population and accounts for 3% of general medical office visits. The descriptive study was carried out in Eastern Afghanistan, Afghan Momand Medical Complex & Research Center, Department of Gastroenterology, during the years 2023-2024. To know the Clinico-Endoscopy of Dyspepsia, for patients who present with investigated Dyspepsia to Gastroenterological OPD & IPD. The study result showed, there were a total of patients 467, and of these patients 230 were Male and 237 were Female. According to the Age, 45 patients were under Age <20, 219 patients were between the ages 21-40 years, 130 patients were between ages 41-60 years and 73 patients were over 60 years of Age. However according to the presentation, 357 patients had Dyspepsia, 59 patients had Dysphagia, 13 patients had Chronic Liver Diseases & Screened for Varices, 3 patients presented after Acid ingestion, 2 patients had Anemia, 11 patients had persistent vomiting and 22 patients had suspected GI-Bleeding. Furthermore in Esophageal findings from a total of 467 patients 34 patients had Esophageal Candidacies, 6 patients had Esophageal Narrowing, 25 patients had Esophageal Growth, 71 patients had Hiatus Hernia, 180 patients had LA Grade A Esophagitis, 21 patients had LA Grade B Esophagitis, 6 patients had LA Grade C Esophagitis, 3 patient had LA Grade D Esophagitis. 16 patients had Lax Lower Esophageal Sphincter, 9 Patients had High-Risk Esophageal Varices, 3 patients had Small Esophageal Varices and 150 patients had Normal Esophagus and in Gastric findings from total all above patients, 4 patients had Antral Gastritis, 50 patients had Corpus Gastritis, 1 patient had Fundal Gastritis, 4 patients had Nodular Gastritis, 199 patients had Pan-Gastritis, 108 patients have Severe Pan Erosive Gastritis, 23 patient had Gastric Erosions, 6 patients had PHG (Portal Hypertensive Gastropathy), 3 Patients had Fundal Varices, 5 patients had Gastric Polyps, 5 patients had Gastric Growth, 2 patients had Pyloric Stenosis, 8 patients stomach not seen due to Esophageal Growth, 67 patients stomach were normal. In the present study there were Duodenal findings from a total of the above patients 48 had Duodenitis, 2 patients had Duodenal Polyps, 2 patients had duodenal ulcers, 1 patient had Duodenopathy, 2 patients had Duodenopathy, 2 patients Duodenum not seen due to Pyloric Stenosis and 413 patients Duodenum were normal. Regarding the habits in our study in which a total of 467 patients were examined 135 of the above patients had snuff habits, 103 patients had smoking habits, 2 patients were Heroin addicts and 227 of the total patients didn’t have any habits (the majority of them were using spicy food, overfeeding, drinking of nonalcoholic beverages, fatty foods, NSAIDs ...) and the higher incidence of Dyspepsia was in Female patients, Also with the age between 21-40 years (43%) patients, Also the higher incidence of Dysphagia 47% were in patients with Age >60 years, the Endoscopy showed that 83% patients had Gastritis also higher incidence regarding the habits 29% had snuff habit and 22% had a smoking habit.

This document has been translated from Spanish into English using ChatGPT. While efforts have been made to ensure accuracy and maintain the original meaning, some nuances or interpretations may differ from the source text. For any clarification, please refer to the original document or contact the author.This brief article addresses the concern arising from the accelerated whirlwind of changes of all kinds experienced by our social systems, some of which have a significant evolutionary impact, largely driven by advances in science and technology. Particular interest has emerged in connecting certain properties inherent to the behavior of complex systems far from equilibrium—such as social systems—under the framework of properties currently studied in Complexity Sciences. The article outlines this concern, which is, for now, merely the beginning of what could develop into a groundbreaking investigation. It references laboratory simulation work aimed at understanding the evolutionary horizons of Chile’s social system. The text includes an example of some graphs that illustrate a potential method for detecting and anticipating possible evolutionary horizons of the social system, based on the role played by certain “attractor variables” within the system. However, the research is still exploratory, and this article serves merely as a general description of the initial concern.

Double-Positive Patients (DPPs), characterized by the simultaneous presence of Anti-Neutrophil Cytoplasmic Antibody (ANCA) and anti-Glomerular Basement Membrane (anti-GBM) antibodies, represent a rare subset in systemic vasculitis. We present two cases of DPPs with renal involvement and review the existing literature to elucidate the clinical characteristics, histopathological findings, management strategies, and prognostic outcomes associated with this condition. Both cases exhibited renal involvement with rapidly progressive glomerulonephritis, requiring renal replacement therapy. Renal biopsies confirmed crescentic glomerulonephritis with features of both anti-GBM disease and ANCA-associated vasculitis. Management included high-dose glucocorticoids, cyclophosphamide, and consideration of plasma exchanges. Double-positive ANCA and anti-GBM vasculitis pose challenges in management and prognosis. Further research is essential to improve therapeutic strategies for this rare and heterogeneous condition.

Chronic Kidney Disease (CKD) is a significant public health issue with a rising prevalence globally. Diabetic kidney disease (DKD), a leading cause of CKD, necessitates improved biomarkers for early detection and effective management. Traditional markers such as serum creatinine, estimated glomerular filtration rate (eGFR), and albuminuria have notable limitations in sensitivity and specificity, especially for early detection. Fetuin-A, specifically its post-translationally modified form (PTM-Fetuin-A), has emerged as a potential novel biomarker for DKD. This study evaluates PTM-Fetuin-A in a cohort of Bulgarian patients with type 1 and type 2 diabetes, assessing its correlation with traditional markers such as albuminuria and eGFR. Significant correlations were observed between PTM-Fetuin-A and these indicators (e.g., Pearson’s r = 0.447, p = 0.025 for albuminuria), highlighting its ability to detect early kidney function decline. Furthermore, PTM-Fetuin-A demonstrated potential as a non-invasive tool for identifying normoalbuminuric DKD, addressing gaps left by conventional biomarkers. By offering additional prognostic value, PTM-Fetuin-A could improve the early diagnosis and clinical management of diabetic patients, reducing the burden of CKD.

Alginate, a naturally occurring biopolymer extracted from brown algae, presents a promising avenue for developing sustainable and efficient membranes for wastewater treatment. This review comprehensively examines recent advancements in the fabrication, modification, and application of alginate-based membranes for effective water purification. The paper delves into various fabrication techniques, including casting, electrospinning, and 3D printing, which influence the structural and functional properties of the resulting alginate membranes. To enhance performance, strategies such as crosslinking, incorporation of porogens, and surface functionalization are employed. These modifications optimize crucial properties like mechanical strength, porosity, selectivity, and antifouling resistance. Furthermore, Response Surface Methodology (RSM) has emerged as a valuable tool for systematically optimizing fabrication parameters, enabling researchers to identify optimal conditions for achieving desired membrane characteristics. The integration of alginate membranes with biological treatment processes, such as phycoremediation (utilizing microalgae) and mycoremediation (employing fungi), offers a synergistic approach to enhance wastewater treatment efficiency. By immobilizing these microorganisms within the alginate matrix, their bioremediation capabilities are amplified, leading to improved pollutant degradation and nutrient removal. In conclusion, alginate-based membranes demonstrate significant potential as a sustainable and effective technology for wastewater treatment. Continued research and development, focusing on optimizing fabrication processes and exploring innovative integration strategies with biological systems, will further advance the application of alginate membranes in addressing the pressing global challenge of water pollution.

Introduction: Behçet’s disease is a rare, systemic, inflammatory condition that primarily affects young adults. It is characterized by a variety of clinical manifestations. However, neurological and cardiac presentations remain uncommon and often delayed in diagnosis. This disease can lead to severe complications, such as ischemic strokes and myocarditis, highlighting the systemic and complex nature of the condition.Case presentation: A 27-year-old patient was hospitalized after experiencing an ischemic stroke and myocarditis, which revealed Behçet’s disease. He had a history of oral and cutaneous ulcers, without a prior diagnosis of Behçet. Upon admission, brain imaging confirmed an ischemic stroke, and echocardiography and cardiac MRI showed acute myocarditis. Biological tests confirmed elevated systemic inflammation, which guided the treatment plan. The initial treatment included corticosteroids, immunosuppressors (azathioprine), and cardioprotective therapy. The patient showed significant clinical improvements, although mild deficits persist.Discussion: Myocarditis in Behçet’s disease is a rare but severe manifestation resulting from inflammation of the heart walls, often associated with other systemic vascular involvement. Although less common than oral or cutaneous ulcers, myocarditis can lead to acute heart dysfunction and even heart failure if not treated promptly. It is generally caused by an excessive inflammatory response, often associated with immune system activation, which affects the coronary circulation and damages the cardiac muscle. Treatment for myocarditis in this context relies on high-dose corticosteroids to control inflammation, followed by long-term immunosuppressive medications like azathioprine. While the initial treatment often leads to a rapid improvement in cardiac function, the risk of long-term complications, such as dilated cardiomyopathy or heart failure, remains high. Close follow-up is therefore essential to prevent these complications and optimize the long-term cardiac prognosis of patients with this rare disease.Conclusion: The progression of myocarditis in Behçet’s disease can be favorable if diagnosed and treated early, with significant improvement in cardiac function achieved through the use of corticosteroids and immunosuppressive therapy. However, the long-term prognosis remains uncertain due to the risk of chronic cardiac complications, such as dilated cardiomyopathy or heart failure.

The article conducted a study of computer acoustic analysis of Jitter and Shimmer voice parameters in children with dysphonia after laryngeal surgery. The study found that children with dysphonia had significantly lower preoperative Jitter and Shimmer scores (574359, 587, and 2.3) compared to healthy children (1316743.376 and 4.84). At 1 month after surgery, affected children showed a decrease in Jitter and Shimmer indices compared with these acoustic indices before surgery. However, at 2 months, there was a significant increase in Jitter and Shimmer scores, and at 3 months, Jitter and Shimmer scores were comparable to Jitter and Shimmer scores in healthy children without dysphonia. The results of the study show that the method of analyzing the acoustic parameters of the voice Jitter and Shimmer allows a phoniatrist to objectively assess the occurrence of a voice disease in patients with dysphonia, and this method is the most accurate criterion for determining the pathologies of dysphonia and determining the treatment program for the disease.

Public-Private Partnership (PPP) road projects are being promoted worldwide to encourage road investments; however, research on the appropriate rate of return for these projects is insufficient. This is likely because the return on investment for PPP road projects is determined through negotiations between the government and the private sector, a process that remains confidential. The rate of return for PPP road projects is not only a key indicator for evaluating project performance but also a potential driver for future government financial subsidies. Therefore, research on the appropriate rate of return for PPP road projects is necessary for the sustainability of these projects.This study, based on the concept that both the government and the private sector share the anticipated risks of the project, quantifies six types of risks and proposes a model for predicting the appropriate rate of return. The model is able to explain approximately 68% of the cases in South Korea’s PPP road projects. The risk with the greatest influence on the rate of return was found to be an economic risk, while the least influential was regulation change risk.Due to the confidentiality of data related to PPP road projects, this study only utilized 54 cases from South Korea. It is hoped that a wider range of data will be collected and further research on the appropriate rate of return will continue to enhance the sustainability of PPP road projects.

Quantum fluctuations, usually arising from the inherent uncertainty in the quantum fields, are pivotal in understanding the universe at both the small and large scales. Even though fluctuations are usually unobservable and rather small, they give significant observable effects during specific epochs under specific conditions. During the early epochs of the universe, the fluctuations were scaled, resulting in the primordial density perturbations that gave rise to the large-scale structure of the universe and the observed inhomogenities. In this paper, we study the basic origin, structure, evolution, and imprints of fluctuations during the inflationary period resulting in large-scale structure formation. We use the Mukhanov-sasaki formalism to model scalar perturbations, embedding the theoretical results into observations. Theoretical predictions show an almost scale-invariant power spectrum with stringent constraints on the inflationary parameters. It further states that in the very early universe, the inflatons that are quanta of the primordial field were highly filled in the degenerate quantum state. This carries large potential energy that results in an exponential expansion of the universe. During post post-inflationary period the inflaton dominated the Universe’s energy density; they interact among themselves and due to non-linear effects, these inhomogeneities grow which amalgamate into spatially distinguishable patches in our observable universe. Our understanding projects us towards the fact that fluctuations play a pivotal role in understanding the structure formation at micro, macro, and far-macro scales. This study also addresses the significance of quantum fluctuations in cosmic evolution and manifests the enduring relevance in addressing some of the profound mysteries of our universe.

Globally, evidence-based healthcare practices are the most dependable framework for effective healthcare decisions and practices. In all nations, financial resources, people, and time are always insufficient. Healthcare professionals should recommend healthcare interventions that have been proven to be safe, effective, and affordable. All healthcare professionals must be creative to be involved in the creation and compilation of trustworthy evidence to support the decrease in morbidity and mortality of communicable and non-communicable diseases, particularly in developing nations. Regretfully, most developing nations still exhibit weaknesses and barriers to promoting health research and evidence-based healthcare. Evidence indicates that developing countries contribute 1% - 2% of health research activities to address global health problems and challenges. As a result, many individuals in these nations continue to have below-average health conditions. The lack of creativity, innovation, and motivation to gain health research competencies for healthcare professionals causes all these issues. Creativity and innovation are the foundations for the effective implementation of evidence-based healthcare. Surprisingly, no researchers have explored how creativity and innovation heighten evidence-based healthcare practices. The primary objective of this project will be to foster pathways and explore the creativity that advances health research abilities among healthcare professionals to improve evidence-based healthcare practices in resource-limited healthcare settings.

Pulmonary Embolism (PE) can present with symptoms resembling pneumonia, creating a diagnostic challenge, particularly in patients with comorbidities. We report the case of a 67-year-old male who presented with cough, hemoptysis, shortness of breath, fever, and pedal edema. Initially diagnosed with consolidation based on chest X-ray findings, he was treated with antibiotics. However, persistent symptoms prompted further evaluation, leading to the diagnosis of PE with pulmonary infarction and deep vein thrombosis on computed tomography pulmonary angiography and Doppler ultrasound. This case highlights the need to consider PE in the differential diagnosis of consolidation, particularly in high-risk individuals, to avoid delays in appropriate management.

Background: CT-guided lung biopsy is routinely performed minimally invasive procedure. Imaging findings in the lung can have a broad differential diagnosis; therefore, it is indicated for definitive determination of pulmonary nodules or masses. Post-biopsy complications are common with most of them manageable in daycare. As pneumothorax is the most common complication, frequency and severity of pneumothorax with assessment of risk factors and follow-up for resolution is necessary.Methods: A prospective evaluation of 123 biopsies with automated coaxial biopsy of 18 gauge was done. Post-biopsy pneumothorax was evaluated for its incidence and resolution. The studied risk factors were; patient age, sex, lesion location, lesion size, shortest pleural lesion depth, traversed lung parenchymal distance, presence of emphysema, fissure penetration, needle thoracic wall angle, and lesion characteristics.Results: Reported immediate post-procedural pneumothorax was 22% with 19% of mild, 4% of moderate and 2.4% of severe cases. 51.9% of cases showed resolution within 24 hours. The intervention was required in only 4.8% of biopsy cases. A significant p - value of pneumothorax with the nodule depth increased traversed lung parenchymal distance, acute needle angle, fissure puncture, and presence of emphysema was seen. Emphysema was an independent variable in pneumothorax in multivariate analysis.Conclusion: Pneumothorax is an unamenable consequence of CT-guided lung biopsy and a cautious approach should be kept in view of the variables that are associated with it to reduce its incidence and severity in patients.

Background: Preterm Birth (PTB) is the largest direct cause of neonatal mortality and the second leading cause of under-five mortality following pneumonia. Although there are studies conducted before, the magnitude of PTB remains a major issue in most developing countries including Yemen. Therefore, this study aims to assess the prevalence and associated factors of premature birth among newborns delivered in Jiblah University Hospital in Ibb governorate, Yemen.Objectives: No studies have previously been conducted about preterm labour in Jiblah University Hospital in Ibb governorate, Yemen.Methods: This retrospective observational study was conducted in the Department of Obstetrics & Gynecology, Jiblah University Hospital in Ibb Governorate, from 1 December 2023 to 29 February 2024.Results: A total of 1350 pregnancies, 252 (18.67%) were preterm deliveries and 1089 (80.66%) were full-term deliveries at Jiblah University Hospital, Ibb. Our study shows the distribution of participants based on socio-demographic factors. The data that out of the total 252 female participants, with ages mean ± std = 27.43 ± 6.34 roughly 18.67% experienced preterm deliveries. Our study demonstrates that several factors are significantly linked to preterm birth, including the number of siblings, blood pressure, gravida, and abortion number, where the Chi-square p - value was < 0.05. On the other hand, the results from the logistic regression analysis indicated the predictive potential of certain socio-demographic factors in relation to preterm birth. Conclusion: In this study, the number of siblings, blood pressure, gravida, and abortion number are the risk factors for premature delivery. Recognizing the most common risk factors for PTB will help to increase awareness about high-risk pregnancy, improve the preventive measures of preterm risk factors, and modify preterm care protocol in nurseries. 

Methylenetetrahydrofolate Reductase (MTHFR) is an important enzyme of the folate cycle, which is required to convert 5,10-methyltetrahydrofolate into 5-methyltetrahydrofolate (5-methylTHHF). 5-methyl THF is a methyl group donor for several cellular methylation processes. It also donates methyl group for the conversion of homocysteine into methionine, the higher concentration of which is toxic. MTHFR gene C677T polymorphism is clinically important polymorphism and the variant MTHFR (A222V) enzyme has reduced activity, hence increasing the requirement for folic acid. Less conversion of folate to 5-methyl-THF due to C677T polymorphism results in a higher plasma concentration of homocysteine (hyperhomocysteinemia). Individuals having C677T polymorphism are susceptible to various diseases, including reproductive problems like male infertility, polycystic ovary syndrome, Recurrent Pregnancy Loss (RPL), Preeclampsia (PE), placental abruption, and adverse pregnancy outcomes. MTHFR C677T polymorphism mimics folate deficiency, and folate is required for DNA synthesis, repair, methylation, and proper chromosome segregation, and all these processes are important for foetal growth and normal development. Methylation and demethylation processes control the gene expression of about 45% of human genes. Impaired methylation influences the expression of genes involved in the regulation of hormones, spermatogenesis, and oogenesis. In males, oxidative stress damages sperm DNA decreases sperm motility, and may impair fertilization capability. In pregnant women, hyperhomocysteinemia increases oxidative stress and inflammation within the placenta, which causes damage to placental tissue, impairs its function, and disrupts foetal development. Further, hyperhomocysteinemia (HHcy) is embryotoxic and neurotoxic and is responsible for congenital anomalies in the foetus. This review supports the idea that MTHFR C677T polymorphism is associated with an increased risk for male infertility, PCOS, RPL, PE, and congenital anomalies. This review may provide a clue toward a better understanding of the correlation between the MTHFR C677T polymorphism and its detrimental effects on human reproductive health.

Bartholinitis, or Bartholin's gland abscess, is a relatively common gynecological condition among women of reproductive age. Its annual incidence is estimated at approximately 0.5 per 1,000 women, which corresponds to a lifetime cumulative risk of about 2%. The condition primarily affects patients between 20 and 50 years old, with a peak frequency observed between 35 and 50 years.After menopause, due to the natural involution of the gland, Bartholin's cysts and abscesses become less frequent, although they can still occur. Moreover, in women over 50, the appearance of a new mass in the gland region should prompt caution, as it may, in rare cases, indicate a carcinoma of the Bartholin's gland or an adjacent vulvar cancer. Therefore, for patients over 40 presenting with a newly emerged cyst or abscess, clinical guidelines recommend performing a biopsy or excision to rule out malignancy. We present the case of a 50-year-old woman with no significant medical history, who was urgently referred to the gynecological emergency department due to confusion, unexplained fever of 40 °C, and resistant leucorrhoea following a week of corticosteroid antibiotic therapy. Clinical examination revealed a large, tender right vulvar mass, indicative of an acute Bartholin's abscess. The patient exhibited signs of septic shock and was admitted to the ICU. Following a diagnosis of sepsis, broad-spectrum antibiotic therapy was initiated, alongside fluid resuscitation and norepinephrine support. Surgical drainage of the abscess confirmed the presence of E. coli. The patient's condition improved rapidly, and she was discharged on postoperative day 8 with no complications. This case underscores that while Bartholin's abscess is typically benign, severe complications, including septic shock, can occur—especially in patients over 50. The appearance of a new Bartholin's region mass in older women should prompt consideration of malignancy, necessitating biopsy or excision. Recent studies compare various therapeutic approaches including simple incision and drainage, Word catheter placement, marsupialization, silver nitrate application, and complete gland excision. Each method has its advantages and drawbacks, with marsupialization offering lower recurrence rates and higher patient satisfaction in many instances. 

The integration of deep learning and genetic analysis has transformed the assessment of elite sports performance, particularly in competitive swimming. This study examines the fusion of deep learning techniques with DNA markers, physiological biometrics, and performance analytics to enhance the prediction and optimization of swimmer performance. A structured dataset comprising genetic sequences, physiological parameters, and biomechanical attributes was utilized to train a neural network model capable of categorizing swimmers based on genetic predisposition and athletic potential. The model achieved high classification accuracy, demonstrating a strong link between genetic markers, physiological traits, and competitive swimming outcomes. The findings emphasize the potential of AI-driven analytics in talent identification, customized training adaptations, and injury prevention. Furthermore, the study highlights the effectiveness of deep learning in analyzing complex genomic and physiological data to generate meaningful insights for performance enhancement. While the results validate the feasibility of using genetic and AI-based models for performance prediction, further studies are needed to broaden dataset diversity, integrate epigenetic influences, and test the model across varied athlete populations. This research contributes to the expanding field of AI-driven sports science and provides a solid foundation for incorporating genomics with deep learning to enhance elite athletic performance.

VACTERL (V: Vertebral anomalies, A: Anal malformation, C: Cardiac defect, TE: Tracheoesophageal malformation, R: Renal anomalies, L: Limb anomalies) is a cluster of congenital malformations. It is a rare association with sporadic and non-random occurrence where multiple organs are affected due to developmental defect during blastogenesis (2-4 weeks of gestation), where abnormal structures are derived from the embryonic mesoderm. Multiple environmental and genetic factors have been implicated. We report the successful management of a patient  with VACTERL association born to a mother through an emergency cesarean section due to fetal distress.